Diabetes Outpatient Care and Acute Complications before and after High-deductible Insurance Enrollment

Details

• Alternative Title:
  JAMA Intern Med
• Personal Author:
  Wharam, J. Frank ; Zhang, Fang ; Eggleston, Emma ; Lu, Christine Y. ; Soumerai, Stephen ; Ross-Degnan, Dennis
• 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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• Subjects:
  • Article
  • Adolescent
  • Adult
  • Ambulatory Care
  • Deductibles and Coinsurance
  • Diabetes Complications
  • Diabetes Mellitus
  • Eligibility Determination
  • Female
  • Health Benefit Plans, Employee
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• Source:
  JAMA Intern Med. 177(3):358-368.
• Pubmed ID:
  28097328
• Pubmed Central ID:
  PMC5538022
• Document Type:
  Journal Article
• Funding:
  P30 DK092924/DK/NIDDK NIH HHS/United States ; U58 DP002719/DP/NCCDPHP CDC HHS/United States
• Place as Subject:
  United States
• Volume:
  177
• Issue:
  3
• Download URL:
  https://stacks.cdc.gov/view/cdc/47222/cdc_47222_DS1.pdf
• File Type:
  [PDF - 364.69 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:233c6d5cc8146bea6993c648d82334313b914ad77a82d18e3334b9ae2c6f22bd