Diabetic patients who are inadvertently switched to a high-deductible health plan (HDHP) have twice the incidence of eye-related diabetes complications, including blindness, and are less likely to have a heart attack or stroke, according to research reported today. The hospitalization rate has increased. JAMA network open.
Lead author Rosalina G. McCoy, Ph.D., associate professor of medicine at the University of Maryland School of Medicine, and colleagues say the study results show that health care is neglected in high-deductible health plans. The results are consistent with other studies. It is thought to help prevent complications of diabetes.
Rosalina G. McCoy, MD, MS
“While preventive services are generally exempt from cost-sharing, chronic disease management services are not, and individuals facing high copays and deductibles may ration or delay needed care. may have to be abandoned or abandoned,” the researchers wrote in the study's discussion section.
Last year, many of McCoy's fellow researchers JAMA network open A study of the same group of diabetics enrolled in high-deductible health plans found that enrollment in a high-deductible health plan was associated with an increased risk of hospital or emergency room visits for severe hyperglycemia. It was done.
People who switched to high-deductible health plans were more than twice as likely to develop end-stage kidney disease and lower extremity complications than those who didn't, according to a study reported today by McCoy and colleagues. Became. We also found that each additional year of high-deductible health insurance coverage increased the risk of diabetes-related complications, a pattern that likely reflects the cumulative effect of deferred or forgone treatment. McCoy and colleagues say that this may be the case.
High deductible health insurance is controversial. Advocates say patients are being exposed to the expense, encouraging them to be more cautious about using health care services and shop around for lower prices. However, McCoy et al.'s study suggests that the effects on health care utilization are not selective. As a result, people lack access to care to prevent complications and prevent chronic conditions from worsening.
McCoy and his colleagues also analyzed some of the interactions between high-deductible health plans and income, ethnicity, and race. The results were somewhat mixed. For example, the association between purchasing high-deductible health insurance and hospitalization for heart attack or heart failure was stronger for high-income people (annual incomes of $40,000 or more) than for low-income people. They also found that the association between having a high-deductible plan and end-stage kidney disease and proliferative retinopathy (a diabetes-related eye disease) was stronger among blacks and Hispanics than among whites, but with fewer hospitalizations for heart attacks. They also found that the association was stronger. weak. The data used by McCoy et al. do not include deaths, so they focus on hospitalizations for heart attacks when people with high-deductible health insurance die from heart attacks outside of hospitals. may be misleading.
Because it is retrospective, McCoy and colleagues cautioned that it is possible to infer a causal relationship between high-deductible health plans and complications from diabetes. Still, the pattern of associations is consistent and impressive. Their data shows that for adults with diabetes, switching to high-deductible health insurance is risky.
- 11% increased risk of hospitalization due to myocardial infarction (heart attack)
- 15% increased risk of hospitalization due to stroke
- 35% increased risk of hospitalization for heart failure
- 253% increased risk of end-stage kidney disease
- 223% increased risk of lower extremity complications
- 117% increased risk of proliferative retinopathy
- 235% increased risk of blindness
- 228% increased risk of retinopathy
This study and a study published last year found that JAMA network open, McCoy and colleagues compared the more than 42,200 adults who switched to high-deductible health plans with the more than 200,000 who did not. They classified a health plan as a high-deductible health plan if the deductible was greater than or equal to the deductible that would qualify a member to participate in a health savings account. In 2010, that deductible was $1,200 per individual. It was gradually increased to $1,300 by 2018. To avoid selection bias, McCoy and his colleagues included only people who voluntarily enrolled in a high-deductible health plan in the high-deductible health plan group in their study. To identify involuntary enrollment, they identified all employer-sponsored insurance plans. Researchers considered enrollment to be involuntary if all employer-sponsored health plans were high-deductible health plans.
The source of all this data was the OptumLabs data warehouse, a database of de-identified administrative claims and electronic health records data managed by Optum, the medical services division of UnitedHealth Group.