OBJECTIVES:High deductible health plans with a Health Savings Account (HDHP/HSA) were introduced in United States since 2003. Per 2015 data, HDHP/HSA has a minimum deductible of $1300/$2600 for single and family coverage. Patients often visit the ER for non-emergency conditions. HDHP/HSA has been promoted as a mean of reducing overutilization of unnecessary care that can be treated in other clinical settings. Also due to high deductible, the OOP costs are expected to be high by individuals. Our objective was to compare the out-of-pocket costs (OOP) and emergency room (ER) visits of individuals enrolled in a HDHP/HSA to individuals not enrolled in a HDHP/HSA.

METHODS:Retrospective database analysis was conducted using 2015 Medical Expenditure Panel Survey (MEPS) data. Sample consisted of all insured individuals aged between 18 years to 65 years. The OOP and ER visits of all individuals enrolled in a HDHP/HSA were compared with those enrolled in a plan with deductible less than the specified limit. An independent two-sample t-test was conducted to compare OOP and ER visits in HDHP/HSA and non HDHP/HSA individuals. The analysis was conducted using SAS 9.3 statistical software. The significance level was set at 0.05.

RESULTS: The sample consisted of 14,858 individuals enrolled in a HDHP/HSA. Majority were White non-Hispanic females in the 45-64 years age group with family income in the range of $23,001-$85,514 per year. The average ER visits was significantly higher (p<0.001) in the HDHP/HSA group (Mean=0.4394) than the comparator group (Mean=0.2195).There was no significant difference in the out-of-pocket expenditure between the individuals enrolled in HDHP/HSA and the comparator group.

CONCLUSIONS: Individuals enrolled in a HDHP/HSA were observed to have more ER visits as compared to individuals enrolled in a health plan with a low deductible. The out-of-pocket expenditure in-case of both groups was found to be similar.