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Diabetes Outpatient Care and Acute Complications before and after High-deductible Insurance Enrollment
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Mar 01 2017
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Source: JAMA Intern Med. 177(3):358-368.
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Details:
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Alternative Title:JAMA Intern Med
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Description:Importance
Effects of modern high-deductible health plans (HDHP) on chronically ill patients and adverse outcomes are unknown.
Objective
Determine HDHP effects on high-priority diabetes outpatient care and preventable acute complications.
Design
Controlled interrupted-time-series.
Setting
A large national health insurer from 2003–2012.
Participants
12,084 HDHP members with diabetes age 12–64. HDHP members were enrolled for one year in a low-deductible (≤$500) plan followed by two years in a HDHP (≥$1000) after an employer-mandated switch. Patients transitioning to HDHPs were propensity-score-matched with contemporaneous patients whose employers offered only low-deductible coverage. Low-income (n=4121) and health savings account (HSA)-eligible (n=1899) diabetes patients were subgroups of interest.
Exposure
Employer-mandated HDHP transition.
Main Outcomes and Measures
High-priority outpatient visits, disease monitoring tests, and outpatient and emergency department visits for preventable acute diabetes complications.
Results
The overall, low-income, and HSA-eligible diabetes HDHP groups experienced increases in out-of-pocket medical expenditures of 49.4% (40.3%,58.4%), 51.7% (38.6%,64.7%), and 67.8% (47.9%,87.8%), respectively, relative to controls in the year after transitioning to HDHPs. High-priority primary care visits and disease monitoring tests did not change significantly in the overall HDHP cohort while high-priority specialist visits declined by 5.5% (−9.6%,−1.5%) and 7.1% (−11.5%,−2.7%) in follow-up years 1 and 2 versus baseline, respectively. Outpatient acute diabetes complication visits were delayed in the overall and low-income HDHP cohorts at follow-up (adjusted hazard ratios: 0.94 [0.88,0.99] and 0.89 [0.81,0.98], respectively). The overall, low-income, and HSA-eligible diabetes HDHP groups experienced increased emergency department acute complication visits of 8.0% (4.6%,11.4%), 21.7% (14.5%,28.9%), and 15.5% (10.5%,20.6%) per year, respectively.
Conclusions and Relevance
Diabetes patients experienced minimal changes in outpatient visits and disease monitoring after a HDHP switch, but low-income and HSA-eligible HDHP members experienced major increases in emergency department visits for preventable acute diabetes complications.
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Pubmed ID:28097328
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Pubmed Central ID:PMC5538022
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