# A hurdle and negative binomial model approach to analyzing the gender differences in diagnostic imaging utilization under high-deductible health plans

## TL;DR

This study finds that high-deductible health plans reduce diagnostic imaging use more in males than females, especially for ultrasound.

## Contribution

The study introduces a hurdle and negative binomial model approach to analyze gender-based differences in imaging utilization under HDHPs.

## Key findings

- HDHPs enrollment led to a 7% overall decline in diagnostic imaging utilization.
- Male enrollees showed an 8.2% greater drop in initial ultrasound use compared to females.
- After initial use, gender differences in imaging utilization among HDHPs enrollees were no longer significant.

## Abstract

High-Deductible Health Plans (HDHPs) have been increasingly adopted as a cost-containment strategy in healthcare. However, their impact on the utilization of diagnostic imaging services, particularly across different genders, remains underexplored. This study explores how HDHPs enrollment affect imaging utilization rates and usage patterns among patients of different genders, and it examines the associated gender disparities across various imaging modalities.

Using data from the 2010 Thomson-Reuters MarketScan Commercial Database, we conducted a quantitative analysis employing Negative Binomial Regression and Hurdle models. The models assessed the association between HDHPs enrollment and diagnostic imaging utilization, with a focus on gender-based differences in usage patterns.

The analysis revealed that males generally utilize diagnostic imaging services less frequently than females. After HDHPs enrollment, overall imaging utilization declined by 7%, with a more pronounced reduction observed among male enrollees. Specifically, the likelihood of initial ultrasound utilization among males dropped by 8.2% more than among females. However, once at least one imaging procedure had been initiated, gender differences in utilization among HDHPs enrollees were no longer significant.

The findings suggest that HDHPs have a gender-differentiated effects on diagnostic imaging utilization, with males experiencing a more significant reduction, especially in the initial use of diagnostic imaging and in the use of ultrasound services. These results highlight the need for gender-sensitive approaches in health insurance policy design and emphasize the importance of targeted patient education to promote equitable access and resource allocation.