Affiliation:
1. Economics, Sociology, and Statistics (ESS) RAND Corporation Santa Monica California USA
2. Fielding School of Public Health University of California Los Angeles (UCLA) Los Angeles California USA
3. School of Medicine University of California San Francisco (UCSF) San Francisco California USA
4. Economics, Sociology, and Statistics (ESS) RAND Corporation Arlington Virginia USA
5. Department of Medicine at Stanford Stanford University Palo Alto California USA
Abstract
AbstractObjectiveEvaluate whether cost‐sharing decreases led high‐deductible health plans (HDHP) enrollees to increase their use of healthcare.Data Sources, Study SettingNational sample of chronically‐ill patients age 18–64 from 2018 to 2020 (n = 1,318,178).Study DesignDifference‐in‐differences analyses using entropy‐balancing weights were used to evaluate the effect of a policy shift to $0 cost‐sharing for telehealth on utilization for HDHP compared with non‐HDHP enrollees. Due to this shock, HDHP enrollees experienced substantial declines in cost‐sharing for telehealth, while non‐HDHP enrollees experienced small declines. Event study models were also used to evaluate changes over time.Data Collection/Extraction MethodsOutcomes included use of any outpatient care; use of $0 telehealth; use of $0 telehealth as a proportion of all outpatient care; and use of any telehealth. To test whether any differences were due to preferences for care modality versus cost‐sharing, we further evaluated use of non‐$0 telehealth as a placebo test.Principal FindingsThere was no difference in change in overall outpatient visits (p = 0.84), with chronicall‐ill HDHP enrollees using less care both before and after the policy shift. However, compared with non‐HDHP enrollees, HDHP enrollees increased their use of $0 telehealth by 0.08 visits over a 9‐month period, a 27% increase (95% CI 0.07–0.09, p < 0.001) and shifted 1.2 percentage points more of their care to $0 telehealth, a 15% increase (ß = 0.01, 95% CI 0.01, 0.01, p < 0.001). However, HDHP enrollees had lower uptake of non‐$0 telehealth than non‐HDHP enrollees (ß = −0.01, 95%CI −0.02, 0.00, p = 0.04).ConclusionsRecent‐but‐expiring federal legislation exempts telehealth from HDHP deductibles for care provided in 2023 and 2024. Our results indicate that extending the protections provided by this legislation could help reduce the gap in access to care for chronically‐ill persons enrolled in HDHPs.
Funder
National Institute on Aging
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