Impact of Consumer-Driven Health Plans (CDHPs) on medication adherence and health care spending.

Abstract

This dissertation is comprised of three papers that look at the impact of Consumer-Driven Health Plans (CDHPs) enrollment on medication adherence, health care expenditure, and incentives of CDHPs for people with different health status. The first paper evaluated the impact of enrolling in full replacement CDHPs on medication adherence for eight therapeutic drug classes. We found that the continuation rate was relatively high for all drug classes, although the CDHP cohort had a lower probability of continuing cardiac and cholesterol drugs. We found that CDHP patients took slightly longer on average to refill their first prescription in the post-year for cardiac, hypertension, cholesterol, and thyroid drugs. The compliance rate dropped over time in both cohorts, but the reduction was bigger among CDHP patients for asthma, cardiac, and cholesterol drugs. We also found that the CDHP patients terminated their continuous drug supply earlier for epilepsy drugs and cholesterol drugs. The second paper examined the long-term impact of enrolling in CDHPs on health care expenditures. We found that enrolling in optional HRAs was associated with higher spending compared with staying in traditional plans. Enrolling in optional HSAs was associated with spending comparable with continuous enrollment in traditional plans, though higher spending was observed in some years. Full replacement HRAs are cost neutral to optional HRAs, while full replacement HSAs saved costs over optional HSAs. The third paper evaluated how health care spending for enrollees in CDHPs might be different for members with different health status, ranging from low risk to high risk. We found that healthy CDHP enrollees tended to spend less in the post-CDHP years than a comparison group of healthy employees who elected to keep their traditional health insurance coverage. However, CDHP enrollees with high predicted spending spent more than their comparison group of traditional health insurance enrollees in the post-CDHP years. Among CDHP enrollees, HSA enrollees with low risk health status spent less than HRA enrollees with comparable health status, whereas HSA enrollees with high risk health status spent more than their comparison group of HRA enrollees.