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Health Plan Switching and Health Care Utilization: A Randomized Clinical Trial
Marina Lovchikova1, Andrew Feher2, Langou Lian2
1Covered California, Sacramento.
JAMA Health Forum
|March 29, 2024
Summary
Informational emails increased enrollment in cost-sharing reduction (CSR) silver plans and practitioner visits among Affordable Care Act (ACA) marketplace enrollees. This highlights how improved affordability can enhance healthcare access.
Area of Science:
- Health Services Research
- Health Economics
- Public Health Policy
Background:
- The Patient Protection and Affordable Care Act (ACA) improved insurance affordability but enrollees still face care access barriers.
- Households receiving unemployment insurance in California's ACA marketplace were targeted due to temporary eligibility for enhanced plans.
Purpose of the Study:
- To assess the impact of informational emails on plan switching to cost-sharing reduction (CSR) silver plans.
- To evaluate the effect of these emails on healthcare utilization among eligible ACA marketplace enrollees.
Main Methods:
- A randomized clinical trial was conducted during the 2021 ACA special enrollment period in California.
- Households were randomized to receive informational emails promoting CSR plan enrollment or a control group.
- Outcomes included CSR plan switching rates and healthcare utilization (practitioner visits, ED visits, hospitalizations, prescription fills).
Main Results:
- Informational emails significantly increased CSR silver 94 plan enrollment by 3.1 percentage points (74.8% relative increase).
- A statistically significant increase of 1.3 percentage points (2.3% relative increase) in practitioner visits was observed.
- No significant effects were found on prescription fills, emergency department visits, or hospitalizations.
Conclusions:
- Informational emails effectively increased enrollment in more affordable health insurance plans.
- Enhanced affordability, driven by CSR plans, is associated with increased utilization of routine healthcare services like practitioner visits.
- These findings underscore the importance of targeted communication in improving healthcare access within ACA marketplaces.
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