Enrollment in plans with high deductibles has increased more than seven-fold in the last decade. Proponents of these plans argue that high deductibles could reduce wasteful spending by providing patients with incentives to limit use of low-value services that offer little or no clinical benefit. Others are concerned that patients may respond to these incentives by reducing their use of medical services indiscriminately and regardless of clinical benefit, which may negatively impact health outcomes. This study uses individual-level insurance claims data (2008–2013) and plausibly exogenous changes in plan offerings within firms over time to estimate the intent-to-treat and local-average treatment effects of high-deductible plan offerings on spending on 24 low-value services received in the outpatient setting. We find that firm offer of a high-deductible plan leads to a 13.7% ($5.23) reduction in average enrollee spending on low-value outpatient services and a 5.2% ($105.77) reduction in overall outpatient spending. We also find reductions in spending on measures of low-value imaging and laboratory services. We find some evidence that offering high-deductible plans disproportionately reduces low-value spending relative to overall spending, indicating that deductibles may be a way to incentivize value-based decision making.

在过去十年中，高免赔额计划的注册人数增加了七倍以上。这些计划的支持者认为，高免赔额可以通过激励患者限制使用提供很少或没有临床益处的低价值服务来减少浪费性支出。其他人担心，患者可能会通过不分青红皂白地减少对医疗服务的使用来回应这些激励措施，而不管临床益处如何，这可能会对健康结果产生负面影响。本研究使用个人层面的保险索赔数据（2008-2013 年）和公司内部计划产品的合理外生变化来估计高免赔额计划产品对 24 低支出的意向治疗和当地平均治疗效果- 在门诊环境中获得的价值服务。我们发现，高免赔额计划的实盘报价导致低价值门诊服务的平均参保者支出减少 13.7%（5.23 美元），整体门诊支出减少 5.2%（105.77 美元）。我们还发现在低价值成像和实验室服务方面的支出有所减少。我们发现一些证据表明，相对于总体支出，提供高免赔额计划会不成比例地减少低价值支出，这表明免赔额可能是激励基于价值的决策的一种方式。