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.
  
  
• Subjects:
  1506 Aged Costs And Cost Analysis Deductibles And Coinsurance Diabetes & Endocrinology Diabetes Mellitus Health Economics Health Expenditures Health Policy Humans
• 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
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:877f6aace3f9f6ec5c33c5742ff95c4677b98e0aa0115c1716e16e3434922b17
• Download URL:
  https://stacks.cdc.gov/view/cdc/121843/cdc_121843_DS1.pdf
• File Type:
  [PDF - 632.19 KB ]