Utilization of Diagnostic Imaging Decreases with High-Deductible Health Plans

In the first nationwide study to directly address the associations between high-deductible insurance plans and the use of diagnostic imaging, researchers at the University of Massachusetts Amherst found that patients enrolled in such health plans use fewer diagnostic tests such as MRI, X-rays and CT scans, than patients without such plans.

HealthDay News – U.S. patients whose health insurance plans have high deductibles undergo fewer diagnostic imaging tests, according to a study published in the February issue of Medical Care.

Researchers analyzed 2010 insurance data from more than 21 million adults nationwide to compare use rates and costs of imaging studies such as X-rays, CT or MRI scans, among others, for patients with and without high-deductible plans. They considered insurance plans with an annual deductible of at least $1,200 for individuals and $2,400 for families to be high deductible. They define low-value diagnostic imaging as those with “marginal medical benefit and potential patient harms” and those that “may promote a cycle of increasing medical intervention conferring little to no benefit.”

After controlling for age, sex, geographic location and health status, the study found that people enrolled in high-deductible plans used 7.5% fewer imaging studies than those in other plans. “This difference in imaging utilization corresponded to a 10.2% difference in imaging payments,” the researchers write. However, once a patient had at least one imaging test, being in a high-deductible plan had little effect on their total use of imaging studies.

“We had hoped to find that patients were reducing use of low-value imaging, but we found they reduced all use similarly,” senior author Kimberley Geissler, PhD, from the University of Massachusetts at Amherst, said in a university news release. “It seems patients are not informed enough to discern which tests are more optional and which are medically necessary.”

Summary and Clinical Applicability

These results raise concerns that high-deductible health plans may not be preferentially reducing low-value diagnostic testing. Future health policy targeted at reducing diagnostic imaging should be combined with efforts to improve patient awareness and education as many patients are unaware of the clinical utility of specific diagnostic imaging modalities. 



Zheng S, Ren ZJ, Heineke J, Geissler KH. Reductions in Diagnostic Imaging with High Deductible Health Plans. Med Care. 2016 Feb;54(2):110-7.