High Health Care Deductibles Burden Many Families

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Studies suggest that significant out-of-pocket costs may harm low-income and chronically ill patients.
Studies suggest that significant out-of-pocket costs may harm low-income and chronically ill patients.

HealthDay News -- According to two studies published in JAMA Internal Medicine, high-deductible health plans have multiplied in recent years and they may pose a significant financial burden on Americans with chronic conditions.

Researchers from the Veterans Administration Ann Arbor Health Care System and Penn State University used data from a national survey of adults under age 65 to assess the impact of high deductibles. 

They examined patients' out-of-pocket costs across a range of chronic health conditions. The study included 17,177 people with high, low or no deductibles. 

About 45% had at least one chronic health condition. Annual out-of-pocket spending on medical care varied greatly, even among patients with the same chronic condition, the researchers found. But contrary to prior studies, people by and large appeared to get the care they needed.

The second study examined diabetes outpatient care and complications after an employer-mandated switch to high-deductible coverage involving 12,084 plan members with diabetes. Overall, there was no significant change in primary care visits or disease-related testing.

However, certain vulnerable patients had negative outcomes. For example, emergency department visits for acute complications among low-income people increased 21.7%. And costs for emergency department visits by patients with health savings accounts rose 29.6%.

"Vulnerable patients with diabetes switching to high-deductible insurance experienced major increases in acute diabetes complications and might require protection under improved health insurance designs," write the authors of the second study.

One author from the first study disclosed receiving consulting fees from SeeChange Health and HealthMine.

References

Segel JE, Kullgren JT. "Health Insurance Deductibles and Their Associations With Out-of-Pocket Spending and Affordability Barriers Among US Adults With Chronic Conditions." JAMA Intern Med. 2017. doi:10.1001/jamainternmed.2016.8419. [Epub ahead of print]

Wharam JF, et al. "Diabetes Outpatient Care and Acute Complications Before and After High-Deductible Insurance Enrollment: A Natural Experiment for Translation in Diabetes (NEXT-D) Study." JAMA Intern Med. 2017. doi:10.1001/jamainternmed.2016.8411. [Epub ahead of print]

Fendrick AM, Chernew ME. "Precision Benefit Design—Using 'Smarter' Deductibles to Better Engage Consumers and Mitigate Cost-Related Non-adherence." JAMA Intern Med. 2017. doi:10.1001/jamainternmed.2016.8747. [Epub ahead of print]

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