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Lower Health Care Spending and Use for People with Chronic Conditions in Consumer-Directed Health Plans

To better understand differences in spending and use across types of health plans, we examine individuals enrolled in consumer-directed health plans (CDHPs) and individuals enrolled in non-CDHP health plans. CDHPs are a type of HDHP that typically include a health savings account (HSA) or a health reimbursement arrangement (HRA). We analyzed a sample of over 10 million individuals under the age of 65 enrolled in a full year of employer-sponsored insurance (ESI) coverage between 2014 and 2016, of which 26% was enrolled in a CDHP. We measured their total spending (whether paid by the plan or the enrollee) and examined use of services across four categories: inpatient facilities, outpatient facilities, professional services, and prescription drugs. Because CDHP and non-CDHP enrollees may differ in other ways that affect their use of care, we cannot attribute all of the differences we observe to differences in plan designs.