Consumer-directed health plans have the potential to significantly reduce health care costs, yet they also may reduce use of recommended preventive care, according to research from RAND Corp. In 2011, approximately 17 percent of Americans with employer-sponsored coverage were enrolled in a consumer-directed plan.

Researchers estimate that if consumer-directed health plans, which have annual deductibles of at least $1,000 per person and include a tax-exempt health reimbursement arrangement or health savings account, encompassed 25 percent of the policies selected by people with employer-based insurance, cost savings in the nonelderly population would be in the range of 1 to 2 percent of health care spending. At 50 percent penetration of these plans, health costs could drop about 4 percent, or $57 billion annually, and at 75 percent, savings would range from 5 to 9 percent annually. Fifty-nine percent of large employers in 2012 offered at least one consumer-directed plan.

The study found that among families enrolled in consumer-directed health plans, about two-thirds of the savings were the result of fewer encounters with health care providers. The other third was caused by lower spending per encounter, suggesting patients were making different choices about tests and treatments. Families in consumer-directed health plans used fewer brand-name drugs, had fewer visits to specialists and had fewer elective hospital admissions than families in traditional plans. The study also found modest first-year reductions in the use of highly recommended care such as childhood vaccinations, cancer screenings and routine testing to monitor patients with diabetes. This was despite the fact that some preventive care was offered at no cost. Researchers suggested that enrollees needed better education about plan features and how to navigate medical decision-making.

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