Patients with Bipolar Disorder, High Deductible Insurance Show Decline in Visits to Non-psychiatrist Mental Health Providers


According to the investigators, payers and employers are increasingly adopting HDHPs in an effort to control rising health care costs.

After switching to a high-deductible health plan (HDHP), patients with bipolar disorder experienced an 11% decline in non-psychiatrist mental health outpatient visits, but no decline in psychiatrist visits, medication use, emergency department visits, and hospitalizations, according to new research published in The American Journal of Managed Care.

According to the investigators, payers and employers are increasingly adopting HDHPs in an effort to control rising health care costs. Supporters argue that providing patients with information about the quality of medical services while exposing them to higher costs will create consumers who seek out higher-value health care, adopt healthy behaviors, and reduce future costs.

The researchers found that in 2018, 58% of covered workers had deductibles of $1000 or more and 26% had deductibles of $2000 or more. In the 1970s and 1980s, however, high cost sharing was generally considered to reduce all health care utilization among all types of patients. Notably, the investigators said the effects of HDHPs on patients with serious mental illness are unknown.

Using a national health insurer’s claims data set with medical, pharmacy, and enrollment data, the investigators identified an intervention group of 2862 members with bipolar disorder who were enrolled for 1 year in a low-deductible plan ($500 or less) and then 1 year in an HDHP ($1000 or more) after an employer-mandated switch. The main outcomes included out-of-pocket (OOP) spending per health care service, mental health-related outpatient visits, emergency department (ED) visits, and hospitalizations.

According to the study results, the mean OOP spending per visit on all mental health office visits, non-psychiatrist mental health provider visits, and psychiatrist visits increased by 21.9%, 33.8%, and 17.8%, respectively, among the group who switched to an HDHP. That group also experienced a 4.6% decline in mental health outpatient visits and a 10.9% decrease in non-psychiatrist mental health provider visits, compared with the control group. Psychiatrist visits, ED visits, and hospitalizations remained the same.

Based on these findings, the investigators concluded that HDHPs do not have a “blunt instrument” effect on health care utilization, as was previously believed in the 1970s and 1980s. However, they said patients appear to make trade-offs in order to preserve important care, neglecting some areas of care in order to maintain others.


Wharam JF, Busch AB, Madden J, et al. Effect of High-Deductible Insurance on Health Care Use in Bipolar Disorder. American Journal of Managed Care; June 16, 2020.,and%20hospitalizations%20did%20not%20change.. Accessed June 23, 2020.

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