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Use of well-child visits in high-deductible health plans
Alison A Galbraith1, Dennis Ross-Degnan, Stephen B Soumerai
1Center for Child Health Care Studies, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Ave, 6th Fl, Boston, MA 02215, USA. alison_galbraith@hms.harvard.edu
Insights
Enrollment in high-deductible health plans (HDHPs) did not affect well-child visit rates when preventive care was exempt from deductibles. These findings suggest HDHPs can be used without compromising essential child preventive care access.
Area of Science:
- Health Services Research
- Pediatric Health
- Health Economics
Background:
- High-deductible health plans (HDHPs) are increasingly common, raising concerns about access to essential healthcare services.
- Preventive care, including well-child visits, is crucial for child development and health maintenance.
- Understanding the impact of HDHPs on utilization of these services is vital for policymakers and families.
Purpose of the Study:
- To investigate the effect of switching to HDHPs on the utilization of well-child visits among children.
- To compare the changes in well-child visit rates for children enrolled in HDHPs versus traditional health plans, with preventive care exempt from deductibles.
Main Methods:
- A pre-post comparative study design was employed.
- Children under 18 were analyzed from a large Massachusetts health plan, comparing those switched to HDHPs with a control group remaining in traditional plans.
- Generalized linear mixed models were used to compare changes in the receipt of recommended well-child visits between baseline and follow-up.
Main Results:
- The study included 1598 children switched to HDHPs and 10,093 controls.
- There was a slight decrease in the proportion of well-child visits received by both HDHP and control groups.
- No statistically significant difference was found in the change of well-child visit receipt between the HDHP and control groups (P = .69).
Conclusions:
- Switching to HDHPs, where preventive services are deductible-exempt, did not alter the rate of recommended well-child visits.
- These findings indicate that HDHPs may not negatively impact the utilization of essential pediatric preventive care when structured appropriately.
Objective:
To examine how enrollment in high-deductible health plans (HDHPs) affects use of well-child visits relative to traditional plans, when preventive care is exempt from the deductible.
Study Design:
Pre-post comparison between groups.
Methods:
We selected children aged <18 years enrolled in a large Massachusetts health plan through employers offering only 1 type of plan. Children were in traditional plans for a 12-month baseline period between 2001 and 2004, then were either switched by a decision of the parent's employer to an HDHP or kept in the traditional plan (controls) for a 12-month follow-up period. Preventive and other office visits were exempt from the deductible and subject to copayments, as in traditional plans. The primary outcome was whether the child received well-child visits recommended for the 12-month period. Using generalized linear mixed models, we compared the change in receipt of recommended well-child visits between baseline and follow-up for the HDHP group relative to controls.
Results:
We identified 1598 children who were switched to HDHPs and 10,093 controls. Between baseline and follow-up, the mean proportion of recommended well-child visits received by HDHP children decreased slightly from 0.846 to 0.841, and from 0.861 to 0.855 for controls. In adjusted models, there was no significant difference in the change in probability that recommended well-child visits were received by HDHP children compared with controls (P = .69).
Conclusions:
Receipt of recommended well-child visits did not change for children switching from traditional plans to HDHPs that exempt preventive care from the deductible.
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