Project Description

The Issue: To hold down the costs of their health care benefits, employers increasingly are switching from established PPO and HMO plans to plans with high deductibles and a personal health spending or savings account – known as consumer-directed health plans (CDHPs). Often lost in discussions of this change is the potential impact on the health and productivity of their employees.

Evidence: We review two strands of the peer-reviewed research literature – the first on the link between CDHPs and medical care utilization, and the second on the impact of treatment adherence on workforce productivity. The general insight from the literature is that CDHPs’ medical and pharmaceutical cost savings may come at the expense of workforce productivity. Specifically:

  • CDHPs likely will contribute to lower medical care utilization and lower health care costs borne by the employer.
  • Some of these savings will come from employees foregoing or delaying beneficial care rather than from avoiding unnecessary tests and procedures or from price-shopping. This is particularly true of chronic health conditions.
  • Avoidance of beneficial care will likely result in lost productivity for some workers – the value of which may exceed the costs of medical care.

Implications for employers: Employers considering a CDHP stand a better chance of realizing reduced costs without incurring unnecessary productivity losses if they approach their plan with the following questions in mind:

  • Does the plan have a demonstrated strategy for informing enrollees of which services are covered for free or at low cost?
  • How does the plan facilitate employees’ abilities to shop around for services when it is feasible to do so?
  • Are there resources employees can consult to help them understand which care options are both indicated and of relatively good value?
  • Is there evidence that covered disease and lifestyle management programs improve health and reduce lost productivity for participants?

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