Unsurprisingly, high-deductible health plans lead to lower utilization of healthcare services. A study by Sandoval et al. (2021) use data from 2007-2019 from Switzerland to show that this is the case.

Participants with high-deductible plans reported forgoing health care more frequently than those with low-deductible plans (331 [13.5%] vs 591 [8.7%]). In adjusted analysis, higher-deductible plans were associated with a greater likelihood of forgoing health care (RII, 2.2; 95% CI, 1.7-3.0; P < .001) independently of socioeconomic status, known comorbidities, and cardiovascular risk factors. Deductible level was associated with forgoing of health care among participants younger than 40 years (RII, 2.5; 95% CI, 1.6-4.0; P < .001) and those aged 40 to 64 years (RII, 1.9; 95% CI, 1.3-2.9; P = .002) but not among those older than 65 years (RII, 2.9; 95% CI, 0.8-10.4; P = .11).

This is of interest since Switzerland’s health care system relies on mandatory private health insurance, but individual deductible levels are strictly regulated to approximately $300, $500, $1000, $1500, $2000, or $2500 during the study time period. The deductibles depend on both an individual’s income and the premium they pay; low-income individuals typically receive subsidies to finance the premium. Any medical costs above this deductible have a 10% coinsurance rate, but this co-insurance has a maximum of $700 USD / year. Dental care, however, is not included in the mandatory Swiss insurance package.



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