HealthDay News — Overall, patients who switch to high-deductible health plans (HDHPs) have a decrease in health care utilization, though high-severity emergency department visit expenditures and hospitalization days increase in members from low-income neighborhoods, according to a study published online in Diabetes Care.

J. Frank Wharam, MBBCh, MPH, 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) insured through a large national health insurer (from 2003 to 2012). HDHP members were enrolled in a low-deductible plan for 1 year and then an HDHP for 1 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%, hospitalizations by 5.6%, direct (nonemergency department-based) hospitalizations by 11.1%, and total health care expenditures by 3.8%. While overall there was no change in adverse outcomes in the HDHP cohort, members from low-income neighborhoods had 23.5% higher high-severity emergency department visit expenditures and 27.4% higher high-severity hospitalization days.

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“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 wrote.


Wharam JF, Zhang F, Eggleston EM, Lu CY, Soumerai SB, Ross-Degnan D. Effect of high-deductible insurance on high-acuity outcomes in diabetes: a natural experiment for translation in diabetes (NEXT-D) study [published online January 30, 2018]. Diabetes Care. doi:10.2337/dc17-1183