- 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.
- 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,
- 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.