title: Are the healthy behaviors of US high-deductible health plan enrollees driven by people who chose these plans? Smoking as a case study.
abstract: OBJECTIVE
  To determine whether negative associations between enrollment in a high-deductible health plan (HDHP) and one exemplar unhealthy behavior--daily smoking--are found only among people who chose these plans.
  
  
  METHODS
  Cross-sectional analysis of nationally-representative data.
  
  
  METHODS
  United States from 2007 to 2008.
  
  
  METHODS
  6,941 privately insured non-elderly adult participants in the 2007 Health Tracking Household Survey.
  
  
  METHODS
  Self-reported smoking status.
  
  
  METHODS
  We classified subjects as HDHP or traditional health plan enrollees with employer-sponsored insurance (ESI) and no choice of plans, ESI with a choice of plans, or coverage through the non-group market. We used multivariate logistic regression to measure associations between HDHP enrollment and daily smoking within each of the 3 coverage source groups while controlling for potential confounders.
  
  
  RESULTS
  HDHP enrollment was associated with lower odds of smoking among individuals with ESI and a choice of plans (AOR 0.55, 95% CI 0.33-0.90) and those with non-group coverage (AOR 0.64, 95% CI 0.34-1.22), though the latter association was not statistically significant. HDHP enrollment was not associated with lower odds of smoking among individuals with ESI and no choice of plans (AOR 1.04, 95% CI 0.69-1.56).
  
  
  CONCLUSIONS
  HDHP enrollment is associated with lower odds of smoking only among individuals who chose to enroll in an HDHP. Lower rates of unhealthy behaviors among HDHP enrollees may be a reflection of individuals who choose these plans.
authors: Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States of America. jkullgre@med.umich.edu
authors: Jeffrey T
authors: JT
authors: Kullgren
authors: Kevin G
authors: KG
authors: Volpp
authors: Daniel
authors: D
authors: Polsky
mesh_terms: D000293:Adolescent; D000328:Adult; D002755:Choice Behavior; D003430:Cross-Sectional Studies; D003625:Data Collection / Q000379:methods / Q000706:statistics & numerical data; D003669:Deductibles and Coinsurance / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D015438:Health Behavior; D006264:Health Benefit Plans, Employee / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012907:Smoking / Q000191:economics*; D014481:United States; D055815:Young Adult