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The Effects of Consumer-Directed Health Plans on Health Care Spending

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  • Anthony T. Lo Sasso
  • Lorens A. Helmchen
  • Robert Kaestner

Abstract

We use unique data from an insurer that exclusively offers high-deductible, "consumer-directed" health plans to identify the effect of plan features, notably employer contributions to the spending account, on health care spending. Our results show that the marginal dollar contributed by the employer to the spending account is entirely spent on outpatient and pharmacy services. In contrast, out-of-pocket spending was not responsive to the amount the employer contributes to the spending account. Our results represent the first plausibly causal estimates of the components of consumer-driven health plans on health spending. The magnitudes of the effects suggest important health care spending consequences to higher employer contributions to spending accounts. Our findings are most directly relevant to health reimbursement arrangement plan designs, though our results are still of value to health savings account plan designs. Copyright (c) The Journal of Risk and Insurance, 2010.

Suggested Citation

  • Anthony T. Lo Sasso & Lorens A. Helmchen & Robert Kaestner, 2010. "The Effects of Consumer-Directed Health Plans on Health Care Spending," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 77(1), pages 85-103.
  • Handle: RePEc:bla:jrinsu:v:77:y:2010:i:1:p:85-103
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    References listed on IDEAS

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    1. Chiappori, Pierre-Andre & Durand, Franck & Geoffard, Pierre-Yves, 1998. "Moral hazard and the demand for physician services: First lessons from a French natural experiment," European Economic Review, Elsevier, vol. 42(3-5), pages 499-511, May.
    2. Dionne, Georges & St-Michel, Pierre, 1991. "Workers' Compensation and Moral Hazard," The Review of Economics and Statistics, MIT Press, vol. 73(2), pages 236-244, May.
    3. Alma Cohen & Peter Siegelman, 2010. "Testing for Adverse Selection in Insurance Markets," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 77(1), pages 39-84.
    4. Keeler, Emmett B & Newhouse, Joseph P & Phelps, C E, 1977. "Deductibles and the Demand for Medical Care Services: The Theory of a Consumer Facing a Variable Price Schedule under Uncertainty," Econometrica, Econometric Society, vol. 45(3), pages 641-655, April.
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    Citations

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    Cited by:

    1. Anne C. Duke & Brenda J. Cude, 2016. "Motivating Personal Contributions to Health Savings Accounts," Journal of Consumer Affairs, Wiley Blackwell, vol. 50(3), pages 652-665, November.
    2. Georges Dionne, 2012. "The Empirical Measure of Information Problems with Emphasis on Insurance Fraud and Dynamic Data," Cahiers de recherche 1233, CIRPEE.
    3. Zarek C. Brot-Goldberg & Amitabh Chandra & Benjamin R. Handel & Jonathan T. Kolstad, 2017. "What does a Deductible Do? The Impact of Cost-Sharing on Health Care Prices, Quantities, and Spending Dynamics," The Quarterly Journal of Economics, Oxford University Press, vol. 132(3), pages 1261-1318.
    4. Haviland, Amelia M. & Eisenberg, Matthew D. & Mehrotra, Ateev & Huckfeldt, Peter J. & Sood, Neeraj, 2016. "Do “Consumer-Directed” health plans bend the cost curve over time?," Journal of Health Economics, Elsevier, vol. 46(C), pages 33-51.
    5. M. Kate Bundorf, 2016. "Consumer-Directed Health Plans: A Review Of The Evidence," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 83(1), pages 9-41, January.
    6. Kaestner, Robert & Sasso, Anthony T. Lo, 2015. "Does seeing the doctor more often keep you out of the hospital?," Journal of Health Economics, Elsevier, vol. 39(C), pages 259-272.
    7. repec:spr:eujhec:v:18:y:2017:i:6:d:10.1007_s10198-016-0827-9 is not listed on IDEAS
    8. Stefan Pichler & Jan Ruffner, 2016. "Does it really make a difference? Health care utilization with two high deductible health care plans," KOF Working papers 16-404, KOF Swiss Economic Institute, ETH Zurich.
    9. Liran Einav & Amy Finkelstein & Paul Schrimpf, 2013. "The Response of Drug Expenditures to Non-Linear Contract Design: Evidence from Medicare Part D," NBER Working Papers 19393, National Bureau of Economic Research, Inc.
    10. Song Chen & Anthony Lo Sasso & Aneesh Nandam, 2013. "Who funds their health savings account and why?," International Journal of Health Economics and Management, Springer, vol. 13(3), pages 219-232, December.

    More about this item

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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