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High-deductible health plans may decrease direct hospitalizations in diabetes
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People with diabetes who transitioned to a high-deductible health plan had fewer direct hospitalizations than they had when enrolled in a low-deductible health plan, but those living in low-income neighborhoods experienced worse outcomes, according to researchers.
J. Frank Wharam, MB, BCh, BAO, MPH, general internist and associate professor in the department of population medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute, and colleagues evaluated data from a large national health insurer from 2003 to 2012 on 23,493 high-deductible health plan members with diabetes. Participants were enrolled in a low-deductible plan for 1 year ( $500 deductible) followed by 1 year in a high-deductible health plan ( $1,000 deductible) after an employer-mandated switch. Participants were matched to 192,842 people whose employers offered only low-deductible coverage. A subgroup of high-deductible health plan members from low-income neighborhoods was also evaluated (n = 8,453).
Researchers sought to determine the effect of transitioning to a high-deductible health plan on ED use, hospital care, adverse outcomes and total health care expenditures.
Participants had a mean age of 51 years, 44% were women, 11% were Hispanic, 36% lived in low-income neighborhoods and 26% lived in low-education neighborhoods.
After the transition, total out-of-pocket medical costs were 30.6% higher on average in the high-deductible health plan group compared with the control group.
Compared with the control group, the high-deductible health plan group had estimated decreases of 4% for overall ED visit, 4.3% for low-severity ED visits, 5.6% for overall and direct hospital admissions and 3.8% for total expenditures.
In the subgroup of high-deductible health plan and low-income neighborhood participants, low-severity ED visits decreased (-8.8%), high-severity ED visits increased (10.5%), direct hospital admissions declined by 10% and total expenditures declined by 2.7%.
Compared with low-income control participants, high-deductible health plan low-income participants experienced increases in high-severity ED visit total expenditures (23.5%) and hospitalization days (27.4%) and a decrease in low-severity ED visit expenditures (-5.5%).
“[High-deductible health plans] had a modest effect on high-acuity utilization and outcomes in the overall diabetes cohort, but the low-income subgroup experienced a substantial and concerning increases in adverse outcomes,” the researchers wrote. “Policymakers and employers should consider approaches for protecting such vulnerable populations, including providing health plans tailored to reduce barriers to care, facilitating medical savings and educating members about [high-deductible health plans].” – by Amber Cox
Disclosures: The authors report no relevant financial disclosures.
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