High-deductible insurance plans affect complications, ED visits in diabetes patients

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  • Low-income patients with high-deductible health plans (HDHPs) may need extra interventions to prevent acute complications.

Why this matters

  • HDHPs have recently become the predominant commercial health insurance arrangement in the United States.

Study design

  • Controlled study using large national health insurer database from 2003-2012.
  • Total 12,084 HDHP members with diabetes enrolled for 1 year in a low-deductible ($500) plan followed by 2 years in an HDHP ($1000) after an employer-mandated switch were propensity-score matched with patients whose employers offered only low-deductible coverage.
  • Funding: Centers for Disease Control and Prevention, National Institute of Diabetes and Digestive and Kidney Diseases,

Key results

  • Mean out-of-pocket medical expenditures increased by 49.4% ($374.6) in HDHP group compared with controls in year after HDHP transition.
  • By follow-up year 2, no significant changes found in annual primary care visits, testing for hemoglobin A1c, low-density lipoprotein cholesterol, microalbumin, or retinal eye examinations.
  • Total annual emergency department complication visits and complication episode expenditures increased by 8.0% and 5.6%, respectively, in overall HDHP group and by 21.7% and 9.5% for 4121 low-income HDHP members compared to controls.


  • Missing data on lab values, medication use, and health insurance premium information.  
  • Not representative of all people with HDHPs.