Those with diabetes forced to switch to HDHPs have more complications
April 9, 2024
Source: McCoy, RG et al JAMA Network Open March 24, 2024 LINK In this analysis, “1” would be those diabetics who remained on plans without high deductibles. This means that a person with diabetes on a high deductible health plan was 11% more likely to have a heart attack compared to a person on a low deductible health plan.
Researchers compared the medical claims of over 42,000 health plan members who had been forced by their employers to switch to a high deductible health plan (HDHP) with a group of over 202,000 diabetics who had maintained coverage in a plan without a high deductible. They found that those who were forced to switch (they were on a traditional health plan the previous year, and their employer offered only HDHPs afterward) had substantially more serious complications of diabetes in the years after they switched to HDHPs.
Furthermore, the researchers found that each additional year on an HDHP was associated with a 7% increase in heart attack, an 8% increase in the rate of stroke, a 31% increase in blindness, a 34% increase in end stage kidney disease, and a 33% increase in lower extremity complications such as ulcers, nerve problems, or blood vessel problems.
Previous studies have shown that those on HDHPs are less likely to get preventive care (even if it was covered without cost sharing), get later diagnosis and treatment for breast cancer and diabetic eye disease, and are more likely to present with complicated appendicitis. Some studies have shown that those who have lower incomesare most likely to forego high value care on HDHPs.
Implications for employers:
High deductible health plans clearly lower medical costs for employers, although it appears that many HDHP members fail to get high value care in some instances.
Employers should educate plan members that preventive care is offered without cost sharing in HDHPs.
This research supports offering members a choice that includes at least one plan without a high deductible.
Employers can set their plan contributions so that low wage workers who could not afford cost sharing from non-preventive care are less likely to choose HDHPs.
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