High-Deductible Insurance Linked to Delayed Care for Diabetes Complications
Participants were enrolled in a low-deductible plan (defined as ≤$500) for a baseline year followed by an employer-mandated switch to a high-deductible plan (defined as ≥$1000).
Mandated enrollment in high-deductible health insurance plans was linked to delays in seeking care for the initial symptoms of macrovascular complications from diabetes, according to study results published in Annals of Internal Medicine.
Researchers in this observational longitudinal study compared matched groups of individuals with diabetes enrolled in employer-sponsored plans with the same large national health insurance company from 2003 to 2012. Participants in the intervention group (n = 33,957) were initially enrolled in a low-deductible plan (defined as ≤$500) for a baseline year followed by an employer-mandated switch to a high-deductible plan (defined as ≥$1000) for a follow-up period of up to 4 years. Members of the matched control group (n = 294,942) were contemporaneously enrolled in a low-deductible plan.
The goal of the study was to assess whether a mandated switch to a high-deductible plan could be associated with delayed care for macrovascular diabetes complications by measuring the number of months it took for individuals in both groups to seek medical care for the initial major symptom, to have their initial diagnostic test, and to have their initial procedure-based treatment for coronary heart disease, cerebrovascular disease, and peripheral artery disease. Differences between groups were then calculated to compare midpoint event rates.
No baseline between-group differences were found. After the baseline year, the midpoint delay in seeking care for the initial major symptom of macrovascular complications was 1.5 months (95% CI, 0.8-2.3) for the intervention group. The intervention group also had a delay of 1.9 months (95% CI, 1.4-2.3) for the first diagnostic test for macrovascular complications and 3.1 months (95% CI, 0.5-5.8) for their initial procedure-based treatment. Clinical outcomes within the groups were not examined in this study.
Study investigators concluded that "mandated enrollment in a high-deductible insurance plan among persons with diabetes was associated with delays in seeking care for the ﬁrst major symptoms of macrovascular disease, the ﬁrst diagnostic test, and the ﬁrst procedure-based treatment over 4 years of follow-up."
Wharam JF, Lu CY, Zhang F, et al. High-deductible insurance and delay in care for the macrovascular complications of diabetes [published online November 20, 2018]. Ann Intern Med. doi:10.7326/M17-3365