To study whether the negative association between enrollment in high‐deductible plans and health care utilization is driven by reverse moral hazard or favorable selection, by examining adults with and without a choice of plans.
2011‐2016 Medical Expenditure Panel Survey Household Component data on nonelderly adults enrolled in employer‐sponsored insurance.
Four types of plans were examined: high‐deductible health plans (HDHPs), consumer‐directed health plans (CDHPs), low‐deductible health plans (LDHPs), and no‐deductible health plans (NDHPs). Multivariate logistic regressions of various measures of health care utilization were conducted to estimate the differences in utilization across plan types among those who had a choice of plans and those who did not.
Among adults with a choice of plans, HDHP enrollees had lower levels of utilization compared with those of the NDHP enrollees for any ambulatory visit, any specialist visit, and most preventive services. Among adults without any choice of plans, the differences between HDHP enrollees and NDHP enrollees were not statistically significant.
The differences between those with and without choice of plans in the relationship between HDHP enrollment and health care utilization might possibly be explained by favorable selection.