• Some honest questions for CDHP advocates

    The following is not snark. They are honest questions for CDHP advocates (or anyone who knows). That I’m asking reflects gaps in my knowledge that I’d like filled. I don’t have more time to chase down the answers right now, but I’ll keep looking myself (I’ve tried a little). I don’t mind being schooled on these, so go to town (if you can) and enlighten me.

    My questions are:

    1. What are some credible estimates of the size of the health care moral hazard problem? That is, how much of national health expenditures are due to unnecessary care (somehow defined) that is induced by third-party payments and other insurance-related effects? Does anybody know this, at least roughly (citations please)?
    2. How much of a dent in expenses attributable to moral hazard can reasonably be expected to be made by CDHP-type plans? Go nuts, imagine everyone in the US had a high-deductible plan (of some sensible type), with some appropriate level of income-based subsidization. How much would we save? On what basis is your estimate (citations please)?
    3. Is this savings a shift in health expenditure level or a change in its rate of growth? The former can look like the latter if accomplished over several years, so I’m talking long-term. What’s the argument that it’s a rate change and not a level shift?
    4. Given that it is unlikely that unnecessary and necessary care (somehow defined) can be perfectly separated, how much appropriate care is also deterred by a maximal expansion of CDHP-type plans? What are the health consequences?

    I am aware that one could calculate some kinds of answer to 1 and 2 using cost-sharing elasticities of demand for care from the RAND health insurance experiment and other studies. I did this partially in a prior post. Has anyone done this fully? The other questions in 4 are also somewhat addressed by the RAND HIE, but I’m looking for a short cut to the punchline, if it’s out there. The question in 3 is perhaps the hardest.

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