Health care use down in diabetes patients with high deductibles
J. Frank Wharam, M.B.B.Ch., M.P.H., from Harvard University in Boston, and colleagues studied the effects of HDHPs on emergency department and hospital care, adverse outcomes, and total health care expenditures among 23,493 HDHP members with diabetes (aged 12 to 64 years) insured through a large national health insurer (from 2003 to 2012). HDHP members were enrolled in a low-deductible plan for one year and then an HDHP for one year after an employer-mandated switch. Patients who transitioned to HDHPs were matched to 192,842 contemporaneous patients with low-deductible employer-based coverage.
The researchers found that after the HDHP transition, emergency department visits declined by 4 percent, hospitalizations by 5.6 percent, direct (nonemergency department-based) hospitalizations by 11.1 percent, and total health care expenditures by 3.8 percent. While overall there was no change in adverse outcomes in the HDHP cohort, members from low-income neighborhoods had 23.5 percent higher high-severity emergency department visit expenditures and 27.4 percent higher high-severity hospitalization days.
"HDHPs had a modest effect on high-acuity utilization and outcomes in the overall diabetes cohort, but the low-income subgroup experienced substantial and concerning increases in adverse outcomes," the authors write.
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