Consumer / Employer

Study: Enrollees in high-deductible plans receive less substance use disorder treatment

Enrollees in high-deductible health plans are 6.6% less likely to receive substance use disorder treatment than those without a high-deductible health plan. Having a high-deductible health plan led to 21% less health plan spending, but an increase of 14% in out-of-pocket spending. This can deter some receiving care, the researchers argued.

Enrollees in high-deductible health plans (HDHP) are 6.6% less likely to receive substance use disorder treatment than those without a high-deductible health plan, a new study found.

The American Journal of Managed Care (AJMC) report, published Wednesday, analyzed deidentified commercial claims data from OptumLabs from 2007 to 2017 to conduct the study.

This 6.6% difference in the use of substance use disorder (SUD) treatment was mostly seen for medication services, inpatient care, intermediate care and ambulatory care, the report also found.

People often choose high-deductible health plans because it includes lower monthly premiums. However, it requires consumers to pay higher healthcare costs themselves before insurance takes over, which can financially hurt those who need more consistent care. Enrollment in these types of plans is quite popular: 22% of employees in 2019 had plans with an annual deductible of more than $2,000, the report stated. Having a high-deductible health plan led to 21% less health plan spending, but an increase of 14% in out-of-pocket spending, compared to non high-deductible health plans, AJMC found. This may deter some from seeking care.

“Indeed, HDHPs have been shown to reduce health care spending, but higher deductibles encourage consumers to forgo care in the short term, leading to adverse outcomes in the long term,” the report said.

More vulnerable patients, such as those with chronic conditions, are more likely to face issues with high-deductible health plans because they need continuous care, which can be costly. This is especially troubling for those struggling with substance use disorder, AJMC said, as they typically need longer treatment and often face mental health challenges and chronic health conditions. Therefore, this movement to high-deductible health plans could be hurting those with substance use disorder.

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“Furthermore, given that SUD is vastly under-treated, that only about 10% of individuals with SUD treatment needs receive treatment, and that access to evidence-based SUD treatments is severely limited in many communities, the shift toward HDHPs might be creating further barriers to SUD diagnosis and treatment,” the report stated.

With more than 700,000 Americans who have died from drug overdoses from 1999 to 2017, AJMC argues it’s important to understand the effect health insurance can have on patients. When consumers are considering which health plan to choose, they should take costs for substance use disorder into account, the researchers said. Additionally, plan benefit managers should be aware of the financial impact high-deductible plans can have on those who struggle with drug addiction, they added.

“It is critical to understand how health insurance design choices may be facilitating or deterring access to lifesaving treatments for SUD,” the report said.

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