The effect on mental health services

In one EBRI study, researchers looked at the impact of moving from preferred provider organization (PPOs) to HDHPs among people with mental health disorders. The study focused on three conditions: major depressive disorder (MDD), anxiety, and attention deficit hyperactivity disorder, since those are common conditions.

The researchers found that:

• Moving from a PPO to an HDHP by people with these conditions reduced the probability of using health care services.
• The number of health services used was also lower among patients with mental health disorders who moved from a PPO to an HDHP. Office visits, prescription drug fills, inpatient days, and emergency department visits all declined.
• Utilization of preventive services, including cancer screenings and some vaccinations, was also negatively affected by the move from a PPO to an HDHP.

At the same time, the move to an HDHP did result in lower overall health care spending by employer-sponsored plans. "Employer spending fell by a greater amount and percentage than overall spending. Employee spending increased because the move from the PPO to the HDHP shifted some pre-deductible spending onto users of health care," the study said.

The researchers also noted the context of such changes in mental health care utilization in the post-pandemic world. "The COVID-19 pandemic has exacerbated mental health issues nationally and in the workplace. Between August 2020 and February 2021, the proportion of adults showing symptoms of MDD or anxiety increased from 36.4% to 41.5%," the study said. "Workers and employers strongly agree that employers have a responsibility for workers' mental health. Employers are looking for ways to address the mental health needs of workers given the current economic climate."

The study ended by discussing the possibility that deductibles could be adjusted in areas such as mental health, to prevent creating disincentives to care.

Overall impact of HDHPs

In other research, EBRI presented evidence that HDHPs do result in more cost-conscious behavior by health care consumers.

EBRI used data from the Consumer Engagement in Health Care Survey and concluded that participants in HDHPs generally are more cost-conscious than enrollees in traditional plans.

Among the findings:

• HDHP enrollees are more likely to check whether a health plan would cover care or a medication (50% HDHP vs. 39% traditional).
• HDHP enrollees are more likely to check the quality rating of a provider or hospital before receiving treatment (38% HDHP vs. 32% traditional).
• HDHP enrollees are more likely to check the price of doctor's visits, medication, or other services before receiving care (36% HDHP vs. 30% traditional).
• HDHP enrollees were more likely than traditional health plan enrollees to have talked to their doctors about other treatment options and costs (33% HDHP vs. 27% traditional).

As with mental health care, the research raised notes of caution about the impact on such cost-conscious behavior on overall utilization.

"The survey also finds that HDHP participants were more likely to have declined a medical procedure because of costs (18% HDHP vs. 12% traditional)," the researcher wrote. "Further, once someone reaches their deductible, EBRI research found they are more likely to use low-value health care services. EBRI has also found that deductibles in non-HDHPs are increasing faster than deductibles in HDHPs, which may reduce the relative effectiveness that HDHPs appear to have in engaging people in cost-conscious decision making."

Read more: 

• 4 charts tracking HDHP, HSA availability among employers
• Unaffordable health care results in more employee sick days
• 3 side effects of HDHPs, and how to monitor and manage them