June 14, 2016
Patients with diabetes who have private insurance with a deductible of $1000 or higher a year experience higher costs and greater care delays, a new study reports.
In the United States, roughly 46% of individuals are enrolled in high deductible health plans (HDHP), but whether type of health plan has an effect on clinical outcomes is unknown. To evaluate the effects of switching from a low-deductible health plan to a HDHP for individuals with diabetes, researchers at Harvard University, led by James Frank Wharam MB, BCh, BAO, MPH, evaluated a national sample of 12,084 individuals with diabetes. Dr Wharam reported the study findings at the American Diabetes Association (ADA) 2016 Scientific Sessions (June 10-14; New Orleans, LA).
Participants who were enrolled for 1 year in a low-deductible (≤$500) plan and then made an employer-mandated switch to a HDHP (≥$1000) for 2 years were compared with other participants whose employers offered only low-deductible plans. Participants were between 12 and 64 years of age. Outcome measures included time to first acute diabetes complication—such as cellulitis, UTI or pneumonia—as well as the total cost of the complication.
When compared with diabetic patients on low-deductible plans, diabetic patients on high-deductible plans delayed their complication-related outpatient visits (hazard ratio [HR] 0.948, P = .049) and had $12,935.40 higher cumulative mean costs per complication.
For participants considered to be high morbidity (n = 3640), likelihood of delaying care was 11% higher (P = .012), and the average cumulative costs per complication episode after 2 years was $19,605.20 higher, than for high-morbidity participants on low-deductible health plans.
Dr Wharam and his colleagues noted that the study's findings aren't generalizable to patients with very high deductibles, Medicaid enrollees, or those who are enrolling in health insurance for the first time, Medscape reported. Still, they do suggest that quality of insurance coverage may have an impact on health outcomes for diabetic patients.
Wharam JF, Zhang F, Morton-Eggleston EB, et al. Effect of high-deductible insurance on acute diabetes complications [abstract]. Presented at American Diabetes Association (ADA) 2016 Scientific Sessions. June 10-14, 2016. New Orleans, LA.
Ault A. High-deductible insurance plans lead to diabetes-care delays. Medscape. June 12, 2016.