Article

Effects of a consumer driven health plan on pharmaceutical spending and utilization.

Department of Finance, Director, Medical Industry Leadership Institute, Carlson School of Management, University of Minnesota, 321 19th Avenue South, Room 3-122, Minneapolis, MN, USA.
Health Services Research (Impact Factor: 2.49). 06/2008; 43(5 Pt 1):1542-56. DOI: 10.1111/j.1475-6773.2008.00857.x
Source: PubMed

ABSTRACT To compare pharmaceutical spending and utilization in a consumer driven health plan (CDHP) with a three-tier pharmacy benefit design, and to examine whether the CDHP creates incentives to reduce pharmaceutical spending and utilization for chronically ill patients, generic or brand name drugs, and mail-order drugs.
Retrospective insurance claims analysis from a large employer that introduced a CDHP in 2001 in addition to a point of service (POS) plan and a preferred provider organization (PPO), both of which used a three-tier pharmacy benefit.
Difference-in-differences regression models were estimated for drug spending and utilization. Control variables included the employee's income, age, and gender, number of covered lives per contract, election of flexible spending account, health status, concurrent health shock, cohort, and time trend. Results. CDHP pharmaceutical expenditures were lower than those in the POS cohort in 1 year without differences in the use of brand name drugs. We find limited evidence of less drug consumption by CDHP enrollees with chronic illnesses, and some evidence of less generic drug use and more mail-order drug use among CDHP members.
The CDHP is cost-neutral or cost-saving to both the employer and the employee compared with three-tier benefits with no differences in brand name drug use.

0 Followers
 · 
139 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: By shifting a greater share of out-of-pocket medical costs to consumers, high-deductible health plans (HDHP) might discourage use of essential outpatient services. The objective of the study was to examine the impact of an HDHP on outpatient visits and associated laboratory and radiology tests. We used a pre-post with comparison group study design to examine the differential change in outpatient service utilization among 7953 adults who were switched from a traditional Health Maintenance Organization plan to an HDHP compared with 7953 adults remaining in traditional plans. HDHP members had full coverage of preventive laboratory tests and modest copayments for outpatient visits, similar to controls, but faced full cost sharing under the deductible for radiology tests and laboratory tests not classified as preventive. Compared with controls, the HDHP group experienced moderate relative decreases in overall office visits (incidence rate ratios=0.91, or a 9% relative reduction; 95% confidence interval: 0.88, 0.94) and visits for higher-priority (0.91; 0.85, 0.97) and lower-priority (0.89; 0.81, 0.99) chronic conditions. There were no significant differences in changes in visit rates for acute higher-priority or lower-priority conditions (both 0.93; 0.86, 1.01) or preventive laboratory tests (0.97; 0.93, 1.02). HDHP members showed moderate relative reductions in the use of general laboratory tests (0.91; 0.86, 0.97) but not radiology tests (0.97; 0.91, 1.03). Chronic outpatient visits declined among HDHP members, although preventive laboratory tests and acute visits remained unchanged. HDHP patients with chronic illnesses who have more contact with the health care system might be more likely to reduce utilization because of increased exposure to costs associated with ambulatory visits.
    Medical care 01/2014; 52(1):86-92. DOI:10.1097/MLR.0000000000000008 · 2.94 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT:  Overall, 25–27 percent of Baby Boomers and Gen Xers who would have had adequate retirement income under return assumptions based on historical averages are simulated to end up running short of money in retirement if today’s historically low interest rates are assumed to be a permanent condition, assuming retirement income/wealth covers 100 percent of simulated retirement expense.  A low-yield-rate environment may have an extremely large impact on retirement-income failure rates when viewed in isolation. However, the impact is muted somewhat when included as part of the entire retirement portfolio (e.g., Social Security benefits, possible defined benefit accruals, and net housing equity).  There appears to be a very limited impact of a low-yield-rate environment on retirement income adequacy for those in the lowest- (pre-retirement) income quartile, given the relatively small level of defined contribution and IRA assets and the relatively large contribution of Social Security benefits for this group. However, there is a very significant impact for the top three income quartiles.
    EBRI issue brief / Employee Benefit Research Institute 06/2013;
  • [Show abstract] [Hide abstract]
    ABSTRACT: The employment-based health benefits system established its roots many years ago. It was during World War II that many more employers began to offer health benefits. Recently, however, both the percentage of workers with employment-based health benefits and the comprehensiveness of such coverage have been declining. This paper examines recent trends in employment-based health benefits. It also considers the likely future of this important workplace benefit in light of shifts from defined benefit to defined contribution models of employee benefits and with regard to the implementation of health reform.
    Inquiry: a journal of medical care organization, provision and financing 08/2012; 49(2):101-15. DOI:10.2307/23480905 · 0.56 Impact Factor

Full-text (2 Sources)

Download
42 Downloads
Available from
May 22, 2014