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Ann Intern Med. 2018 Nov 20. doi: 10.7326/M17-3365. [Epub ahead of print]

High-Deductible Insurance and Delay in Care for the Macrovascular Complications of Diabetes.

Author information

1
Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (J.F.W., C.Y.L., F.Z., M.C., X.X., J.W., S.S., D.R.).
2
Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, and Harvard Kennedy School and National Bureau of Economic Research, Cambridge, Massachusetts (J.P.N.).

Abstract

Background:

Little is known about the long-term effects of high-deductible insurance on care for chronic medical conditions.

Objective:

To determine whether a transition from low-deductible to high-deductible insurance is associated with delayed medical care for macrovascular complications of diabetes.

Design:

Observational longitudinal comparison of matched groups.

Setting:

A large national health insurer during 2003 to 2012.

Participants:

The intervention group comprised 33 957 persons with diabetes who were continuously enrolled in low-deductible (≤$500) insurance plans during a baseline year followed by up to 4 years in high-deductible (≥$1000) plans. The control group included 294 942 persons with diabetes who were enrolled in low-deductible plans contemporaneously with matched intervention group members.

Intervention:

Employer-mandated transition to a high-deductible plan.

Measurements:

The number of months it took for persons in each study group to seek care for their first major macrovascular symptom, have their first major diagnostic test for macrovascular disease, and have their first major procedure-based treatment was determined. Between-group differences in time to reach a midpoint event rate were then calculated.

Results:

No baseline differences were found between groups. During follow-up, the delay for the high-deductible group was 1.5 months (95% CI, 0.8 to 2.3 months) for seeking care for the first major symptom, 1.9 months (CI, 1.4 to 2.3 months) for the first diagnostic test, and 3.1 months (CI, 0.5 to 5.8 months) for the first procedure-based treatment.

Limitation:

Health outcomes were not examined.

Conclusion:

Among persons with diabetes, mandated enrollment in a high-deductible insurance plan 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.

Primary Funding Source:

National Institute of Diabetes and Digestive and Kidney Diseases.

PMID:
30458499
DOI:
10.7326/M17-3365

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