Trends in high deductible health plan enrolment and spending among commercially insured members with and without chronic conditions: a Natural Experiment for Translation in Diabetes (NEXT-D2) Study

Details

• Alternative Title:
  BMJ Open
• Personal Author:
  Garabedian, Laura F ; Zhang, Fang ; LeCates, Robert ; Wallace, Jamie ; Ross-Degnan, Dennis ; Wharam, James F
• Description:
  Objectives ; To examine trends in high deductible health plan (HDHP) enrolment among members with diabetes and cardiovascular disease (CVD) compared with healthy members and compare out-of-pocket (OOP) and total spending for members with chronic conditions in HDHPs versus low deductible plans. ; Design ; Descriptive study with time trends. ; Setting ; A large national commercial insurance database. ; Participants ; 1.2 million members with diabetes, 4.5 million members with CVD (without diabetes) and 18 million healthy members (defined by a low comorbidity score) under the age of 65 years and insured between 2005 and 2013. ; Outcome measures ; Percentage of members in an HDHP (ie, annual deductible ≥$1000) by year, annual mean OOP and total spending, adjusted for member sociodemographic and employer characteristics. ; Results ; Enrolment in HDHPs among members in all disease categories increased by 5 percentage points a year and was over 50% by 2013. On average, over the study period, HDHP enrolment among members with diabetes and CVD was 2.84 (95% CI: 2.78 to 2.90) and 2.02 (95% CI: 1.98 to 2.05) percentage points lower, respectively, than among healthy members. HDHP members with diabetes, CVD and low morbidity had higher annual OOP costs ($636 (95% CI: 630 to 642), $539 (95% CI: 537 to 542) and $113 (95% CI: 112 to 113)) and lower total costs (−$529 (95% CI: −597 to −461), −$364 (95% CI: −385 to −342) and −$79 (95% CI: −81 to −76)), respectively, than corresponding low deductible members when averaged over the study period. Members with chronic diseases had yearly OOP expenditures that were five to seven times higher than healthier members. ; Conclusion ; High HDHP enrolment coupled with the high OOP costs associated with HDHPs may be particularly detrimental to the financial well-being of people with diabetes and CVD, who have more healthcare needs than healthier populations.
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• Subjects:
  • Health Policy
  • 1506
  • health policy
  • diabetes & endocrinology
  • health economics
  • Aged
  • Costs and Cost Analysis
  • Deductibles and Coinsurance
  • Diabetes Mellitus
  • Health Expenditures
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• Source:
  BMJ Open. 2021; 11(9)
• Pubmed ID:
  34518242
• Pubmed Central ID:
  PMC8438755
• Document Type:
  Journal Article
• Funding:
  P30 DK092924/DK/NIDDK NIH HHSUnited States/ ; U18DP006122/ACL/ACL HHSUnited States/
• Volume:
  11
• Issue:
  9
• Download URL:
  https://stacks.cdc.gov/view/cdc/121843/cdc_121843_DS1.pdf
• File Type:
  [PDF - 632.19 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:877f6aace3f9f6ec5c33c5742ff95c4677b98e0aa0115c1716e16e3434922b17