High-deductible health plans may lead to delayed care visits, increase health care costs

Issue: July 2016

NEW ORLEANS — Delays in acute complication visits and increases in costs per complication episode are common among people with diabetes who have high-deductible health plans compared with traditional plans, according to a presenter here.

“High-deductible health insurance plans have lower monthly premiums than traditional health plans but a potential out-of-pocket cost of approximately $1,000 to $10,000 per year for nonpreventive services,” James Frank Wharam, MB, BCh, BAO, MPH, associate professor and general internist at Harvard Medical School and Harvard Pilgrim Health Care Institute, said during his presentation. “Advocates believe that these plans will increase quality and reduce costs, and critics fear that the opposite will happen. High-deductible health plan growth has been rapid and is likely to explode partly due to provisions of the Affordable Care Act.”

Wharam and colleagues evaluated a national sample from the Optum health insurance claims database on 12,084 high-deductible health plan members with diabetes aged 12 to 64 years.

Participants were enrolled in a low-deductible health plan for 1 year ( $500) but were then mandated to switch to a high-deductible health plan ( $1,000); they were in the plan for at least 2 years. The study was conducted from 2002 to 2012.

“We hypothesized that high-deductible enrollment would lead to delayed outpatient complication visits,” Wharam said. “Delayed outpatient complication visits might accelerate ED complication visits, increase total ED complication visits and increase the severity of ED complication visits, which we measure by total cost.”

Participants were compared with controls whose employers offered only low-deductible plans. Outcomes included time to first acute diabetes complication, total cost of the first complication, total ED complication visits and total ED complication episode expenditure.

Compared with controls, participants with high-deductible plans delayed their first acute complication visit (P = .049) and cumulative mean costs per episode were $12,935.40 higher after 2 years. Acute complication visits were delayed by high morbidity participants with high-deductible plans (P = .012), and they experienced a $19,605.20 absolute increase in cumulative costs per complication episode after 2 years. Participants living in a low-income household also delayed their first visit (P = .049) and had a cost per episode of $8,217.70.

“We found delayed outpatient visits for diabetes complications but no detectible changes in ED care for diabetes complications, but among the low-income and high-morbidity participants we found a delay in visits for diabetes complications again. This was associated with increased cost of ED complication visit episodes,” Wharam said. “This might imply that more vulnerable patients with diabetes and high-deductible health plans might be experiencing more adverse outcomes and increased financial burden.” – by Amber Cox

Reference:

Wharam JF, et al. 114-OR. Presented at: American Diabetes Association Scientific Sessions; June 10-14, 2016; New Orleans.

Disclosure: The researchers report no relevant financial disclosures.