Are the healthy behaviors of US high-deductible health plan enrollees driven by people who chose these plans? Smoking as a case study

• Published in: PloS one 2013-02, Vol.8 (2), p.e56154-e56154
• Main Authors: Kullgren, Jeffrey T, Volpp, Kevin G, Polsky, Daniel
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Automobile insurance; Case reports; Case studies; Choice Behavior; Consumer-driven health plans; Cross-Sectional Studies; Data Collection - methods; Data Collection - statistics & numerical data; Deductibles and Coinsurance - economics; Deductibles and Coinsurance - statistics & numerical data; Employers; Female; Geriatrics; Health Behavior; Health Benefit Plans, Employee - economics; Health Benefit Plans, Employee - statistics & numerical data; Health care policy; Health insurance; Health savings accounts; Humans; Insurance coverage; Logistic Models; Male; Medicine; Middle Aged; Multivariate Analysis; Older people; Physical fitness; Regression analysis; Smoking; Smoking - economics; Social and Behavioral Sciences; Statistical analysis; United States; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0056154

To determine whether negative associations between enrollment in a high-deductible health plan (HDHP) and one exemplar unhealthy behavior--daily smoking--are found only among people who chose these plans. Cross-sectional analysis of nationally-representative data. United States from 2007 to 2008. 6,941 privately insured non-elderly adult participants in the 2007 Health Tracking Household Survey. Self-reported smoking status. We classified subjects as HDHP or traditional health plan enrollees with employer-sponsored insurance (ESI) and no choice of plans, ESI with a choice of plans, or coverage through the non-group market. We used multivariate logistic regression to measure associations between HDHP enrollment and daily smoking within each of the 3 coverage source groups while controlling for potential confounders. HDHP enrollment was associated with lower odds of smoking among individuals with ESI and a choice of plans (AOR 0.55, 95% CI 0.33-0.90) and those with non-group coverage (AOR 0.64, 95% CI 0.34-1.22), though the latter association was not statistically significant. HDHP enrollment was not associated with lower odds of smoking among individuals with ESI and no choice of plans (AOR 1.04, 95% CI 0.69-1.56). HDHP enrollment is associated with lower odds of smoking only among individuals who chose to enroll in an HDHP. Lower rates of unhealthy behaviors among HDHP enrollees may be a reflection of individuals who choose these plans.