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High-deductible insurance associated with delayed care in diabetes
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Adults in lower income brackets who have diabetes and a high-deductible insurance plan had fewer primary care, checkup and specialty visits vs. those with no deductible, according to a secondary analysis of Medical Expenditure Panel Survey data.
“The reductions are striking for lower-income respondents with a [high-deductible plan]: 42% fewer primary care visits, 65% fewer checkups and 86% fewer specialty visits,” David L. Rabin, MD, MPH, of the department of family medicine at Georgetown University School of Medicine in Washington, D.C., and colleagues wrote. “The substantial reduction in checkup (preventive) and specialty visits by those with a lower income who have a [high-deductible health plan] implies a very different pattern of service use compared with lower-income respondents who have [no deductible] and with higher-income respondents.”
Rabin and colleagues analyzed data from 1,461 privately insured enrollees with diabetes who answered questions about annual deductibles as part of the 2011-2013 Medical Expenditure Panel Survey (MEPS). Researchers stratified respondents by income groups (lower income, < 200% of federal poverty level; and higher income, 200% of federal poverty level) and by annual deductible status (no annual deductible; low deductible, < $1,200 per person and < $2,400 per family; and high deductible, $1,200 per person and $2,400 per family). Those with a health savings account were included in the high-deductible category. Researchers also used 2012-2014 National Health Interview Survey data to analyze differences in medical debt and delayed/avoided needed care among adult respondents with diabetes (n = 4,058) by income.
Within the cohort, 17% had a lower income; 83% had a higher income. Within the low-income group, 29% had no deductible, 49% had a low deductible and 22% had a high deductible. Within the high-income group, 31% had no deductible, 45% had a low deductible and 24% had a high deductible.
After adjustment, respondents with diabetes and a lower income with a high-deductible plan had fewer primary care, checkup and specialty care visits vs. those with no-deductible plans; OR for primary care was 0.576 (95% CI, 0.4-0.83); OR for checkups was 0.346 (95% CI, 0.2-0.61); OR for specialty visits was 0.144 (95% CI, 0.05-0.45). Higher-income respondents with a low-deductible plan had fewer ED and specialty visits vs. other deductible categories.
Low-income respondents with diabetes who had a high-deductible plan and medical debt were also more likely to delay or avoid needed care vs. those with a higher income, according to researchers (53% vs. 28.3%; P = .007). There were no between-group differences observed for diabetes care measures by insurance or income category.
“Patients with diabetes benefit from assessment of diabetes control, encouragement and reinforcement of behavior change and medication use, and early detection and treatment of diabetes complications or concomitant disease,” the researchers wrote. “Because visits by lower-income patients with diabetes who have a [high-deductible plan] are so few, it is incumbent on clinicians to use their visits to fully assess diabetes status and reinforce recommendations for behavior change and adherence to medication.” – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
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