Shopping for Lower‐Priced Care: Do High‐Deductible Health Plans Affect Price Paid for Childbirth

Abstract

Research ObjectiveHigh‐deductible health plans (HDHPs) are one of the most popular types of benefit designs and aim to increase patient engagement through increased financial responsibility for care. Whether HDHPs result in more discernment of providers by price is still unclear and important for assessing overall impacts of these designs. One well‐identified study of a firm showed quantity reductions without price reductions, but its results may have limited generalizability because of the specificity of setting. Additionally, no studies to date have examined whether the number of potential provider choices in a market affects the likelihood of paying a lower price among HDHP enrollees. This study aims to assess whether previous results are generalizable and test whether there were differences by the number of provider choices in a market by studying one commonly shopped‐for service, childbirthStudy DesignI use a 5‐year panel of administrative claims data from three large commercial insurers with plans in all 50 states provided by the Health Care Cost Institute. First, I identify HDHP enrollees who are part of a large group that switched from all non‐HDHPs in one year to HDHPs in a subsequent year, implying a full employer rollover. I measure the negotiated transaction prices for uncomplicated childbirth, a commonly shopped‐for service, prior to and after the HDHP switch, compared with matched controls in the same markets that did not switch plan types. Finally, I construct a measure of the number of hospitals in each market who provide childbirth services. I use that measure with a triple‐differences strategy to measure whether prices paid differ post‐rollover for enrollees in markets with more provider choices compared to those with fewer choices.Population StudiedPrivately insured U.S. women.Principal FindingsFor the full sample, I find that price for childbirth is unaffected by the switch to HDHP. However, for women in markets with more choices, the prices drop by a relative 3 percent after switching to an HDHP. In further testing, I add provider fixed effects to the equation and find that these effects, and not a choice of lower‐price providers, explain the majority of the observed drops in prices in markets with more choices.ConclusionsI find evidence of lower prices for HDHP enrollees in certain markets, through the channel of lower provider prices. Evidence is not consistent with HDHP enrollees choosing lower‐price providers. It is possible that HDHPs could result in lower prices through re‐negotiation of contracts with providers or by employers more aggressively pursuing lower‐cost insurers. These results confirm earlier results showing no evidence of price shopping, but do raise the question of whether prices may decrease in HDHPs through other channels.Implications for Policy or PracticeHDHPs do not encourage shopping for childbirth, even in markets with a considerable number of provider choices. To encourage such behavior, consumers may need additional support. However, HDHPs may lower prices through other channels, namely network formation or provider negotiations. These mechanisms should be explored further.Primary Funding SourceAgency for Healthcare Research and Quality.