title: Use of well-child visits in high-deductible health plans.
abstract: OBJECTIVE
  To examine how enrollment in high-deductible health plans (HDHPs) affects use of well-child visits relative to traditional plans, when preventive care is exempt from the deductible.
  
  
  METHODS
  Pre-post comparison between groups.
  
  
  METHODS
  We selected children aged <18 years enrolled in a large Massachusetts health plan through employers offering only 1 type of plan. Children were in traditional plans for a 12-month baseline period between 2001 and 2004, then were either switched by a decision of the parent's employer to an HDHP or kept in the traditional plan (controls) for a 12-month follow-up period. Preventive and other office visits were exempt from the deductible and subject to copayments, as in traditional plans. The primary outcome was whether the child received well-child visits recommended for the 12-month period. Using generalized linear mixed models, we compared the change in receipt of recommended well-child visits between baseline and follow-up for the HDHP group relative to controls.
  
  
  RESULTS
  We identified 1598 children who were switched to HDHPs and 10,093 controls. Between baseline and follow-up, the mean proportion of recommended well-child visits received by HDHP children decreased slightly from 0.846 to 0.841, and from 0.861 to 0.855 for controls. In adjusted models, there was no significant difference in the change in probability that recommended well-child visits were received by HDHP children compared with controls (P = .69).
  
  
  CONCLUSIONS
  Receipt of recommended well-child visits did not change for children switching from traditional plans to HDHPs that exempt preventive care from the deductible.
authors.affiliation: Center for Child Health Care Studies, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Ave, 6th Fl, Boston, MA 02215, USA. alison_galbraith@hms.harvard.edu
authors.forename: Alison A
authors.initials: AA
authors.lastname: Galbraith
authors.forename: Dennis
authors.initials: D
authors.lastname: Ross-Degnan
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Soumerai
authors.forename: Allyson M
authors.initials: AM
authors.lastname: Abrams
authors.forename: Kenneth
authors.initials: K
authors.lastname: Kleinman
authors.forename: Meredith B
authors.initials: MB
authors.lastname: Rosenthal
authors.forename: J Frank
authors.initials: JF
authors.lastname: Wharam
authors.forename: Alyce S
authors.initials: AS
authors.lastname: Adams
authors.forename: Irina
authors.initials: I
authors.lastname: Miroshnik
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Lieu
mesh_terms: D000293:Adolescent; D002648:Child; D002669:Child Welfare / Q000706:statistics & numerical data; D002675:Child, Preschool; D003669:Deductibles and Coinsurance / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs; D006293:Health Promotion / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008404:Massachusetts; D015999:Multivariate Analysis; D010372:Pediatrics / Q000191:economics / Q000706:statistics & numerical data*; D017061:Prepaid Health Plans / Q000706:statistics & numerical data*; D011314:Preventive Health Services / Q000191:economics / Q000706:statistics & numerical data*; D013997:Time Factors