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High-deductible insurance plans linked to delays in diabetes care
Patients with diabetes enrolled in mandated high-deductible insurance plan demonstrated delays in seeking care for symptoms of macrovascular disease, as well as diagnostic testing and treatments, according to research published in Annals of Internal Medicine.
“Little is known about the long-term effects of high-deductible insurance on care for chronic medical conditions,” J. Frank Wharam, MB, BCh, BAO, MPH, associate professor of population medicine at Harvard Medical School, and colleagues wrote.
Wharam and colleagues analyzed data from a large national health insurer to examine whether high-deductible insurance was associated with delayed medical care for macrovascular complications among patients with diabetes.
Participants were divided into either the intervention group (n= 33,957) or the control group (n = 294,942). Those in the intervention group were enrolled in a low-deductible insurance plan, defined as costing $500 or less, for 1 year followed by up to 4 years in a high-deductible plan, defined as costing $1,000 or more. Those in the control group were enrolled in a low-deductible plan for the entirety of the study period.
The researchers documented how many months it took for participants to seek care for their first major macrovascular symptom and have their first related testing and procedure-based treatment for macrovascular disease.
There were no statistically significant baseline differences in time to any measure between the two groups. Compared with the control group, the intervention group had a 43% (95% CI, 35-51) to 53% (95% CI, 42-63) increase in out-of-pocket medical expenditures per follow-up year vs. baseline.
In the high-deductible group, there was a 1.5-month (95% CI, 0.8-2.3) delay in seeking care for the first major symptom, a 1.9-month (95% CI, 1.4-2.3) delay for the first diagnostic test and a 3.1-month (95% CI, 0.5-5.8) delay for the first procedure-based treatment during follow-up.
“Our study indicates that these delays or reductions persisted over a relatively long follow-up and occurred even for services that are used for life-threatening conditions,” Wharam and colleagues concluded. “These findings raise the possibility that patients in high-deductible plans present with more advanced disease; experience more adverse events, such as strokes, myocardial infarctions, and amputations; and have a higher death rate.”
“We recommend that clinicians and care management teams monitor the type of insurance that patients with diabetes have and consider further outreach and education for those with high-deductible plans,” they added.
In an accompanying editorial, Mark V. Pauly, PhD, professor of health care management at the University of Pennsylvania, wrote that the findings by Wharam and colleagues add to the discussion of whether and when high-deductible health plans should be used for patients.
“Confidence that they are not for patients with known diabetes is enhanced by this research,” they wrote. “High cost sharing is a powerful tool; the authors prudently recommend caution to employers and policymakers considering high-deductible plans. One thing is certain: The switch is going to be a bumpy ride.”
Other recent research has shown the impact financial constraints play in seeking health care, including a survey that found that nearly half of all Americans forgo medical care because of cost and a study that revealed that women were more likely to not take diabetes medications due to cost. – by Alaina Tedesco
Disclosures: Pauly and Wharam report no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.