Quality of Health Care After Adopting a Full-Replacement, High-Deductible Health Plan With a Health Savings Account : A Five-Year Study

This paper reports use of health care services related to health care quality over five years among over 18,000 individuals from a single large employer in the Midwestern United States that adopted an HSA-eligible health plan for all employees. It represents one of the longest observation periods reported with a full-replacement CDHP, and it is one of the few studies with a matched control group. The introduction of the HSA-eligible health plan had a negative impact on office visits for annual physicals, well-child visits, and preventive visits in the year that the plan was adopted. In the second year, office visits increased for HSA-eligible health plan enrollees, but were mostly unchanged for the comparison group. By the fourth year in the HSA-eligible health plan, office visits for annual physicals, well-child visits, and preventive visits were down slightly relative to the comparison group. Rates of LDL testing for adults with cardiovascular disease were reduced only in the first year of the HSA-eligible health plan. However, the introduction of the HSA-eligible health plan had a negative effect on medication monitoring for adults on select maintenance drugs not only in the first year that the new health plan was introduced, but in the following three years as well. The HSA-eligible health plan reduced avoidance of both antibiotics for adults with acute bronchitis and imaging services for adults diagnosed with low back pain. Both services are often considered unnecessary. Adoption of the HSA-eligible health plan was associated with a reduction in breast cancer, cervical cancer, and colorectal cancer screening in year one, although screenings for breast cancer and cervical cancer rebounded in year two. By year four, breast cancer screening was higher among enrollees in the HSA-eligible health plan than in the comparison group. In contrast, cervical cancer screening was lower among HSA-eligible health plan enrollees than the comparison group in year four. Throughout all of the study years, colorectal cancer screening was lower among HSA-eligible health plan enrollees than in the comparison group. The HSA-eligible health plan was not associated with a change in the percentage of adults receiving HbA1c testing until the fourth year. LDL testing was lower as a result of the introduction of the HSA-eligible health plan in all years