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Forum for Health Economics & Policy

Editor-in-Chief: Goldman, Dana

2 Issues per year


How Do Consumer-Directed Health Plans Affect Vulnerable Populations?

Amelia M Haviland1 / Neeraj Sood2 / Roland McDevitt3 / M Susan Marquis4

1RAND Corporation,

2University of Southern California,

3Towers Watson,

4RAND Corporation,

Citation Information: Forum for Health Economics & Policy. Volume 14, Issue 2, ISSN (Online) 1558-9544, DOI: 10.2202/1558-9544.1248, April 2011

Publication History

Published Online:

We use health care claims data from 59 large employers to estimate how consumer-directed health plans (CDHPs)—plans that combine a high deductible with personal accounts—affect health care costs and the use of preventive services by vulnerable populations. The vulnerable populations studied are those that will have increased access to health insurance under health care reform: families with high health care needs and low income families. A difference-in-difference framework is used with costs and use available for a full year before and after enrolling in a CDHP and for controls.

Our key finding is that in almost all cases, CDHP benefit designs affect lower income populations and the chronically ill to the same extent as non-vulnerable populations. These effects include significant reductions in overall spending that increase with the level of the deductible and greater reductions for high deductible plans when paired with health savings accounts (HSAs) in comparison to health reimbursement arrangements (HRAs). However, enrollment in CDHPs also leads to reductions in care that is considered beneficial for all groups, and this may have greater health consequences for lower income and chronically ill people than for others.

Keywords: consumer-directed health plans; vulnerable populations; health care costs; preventive care

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