Diabetics with high-deductible health plans are more likely to delay care

(Reuters Health) – According to a US study, diabetic workers who opt for high-deductible health care plans and who have to pay more for health care may be more likely than those who maintain low-deductible diets to delay the necessary examinations.

People with diabetes are at risk for life-threatening blood vessel disease. If left untreated, these conditions can lead to complications such as a heart attack, stroke and amputation.

For this study, researchers examined data on nearly 34,000 people with diabetes who initially had employer-sponsored health plans with deductibles of $ 500 or less, but their employers offered only plans with deductibles of $ 1,000 or more. The study team also examined a control group of nearly 295,000 workers with diabetes whose deductibles were systematically $ 500 or less.

Before the first group switched to higher deductible health care plans, there was no significant difference in the time patients were waiting for care for potentially life-threatening complications without treatment in due course, according to the study.

However, in the four years since the departure of some employers to offer only high-deductible plans, patients on these plans have expected an average of 1.5 months more than those with reduced-deductible plans. to seek treatment for new symptoms of cardiovascular complications associated with diabetes, 1.9 months for diagnostic tests and 3.1 months for medical procedures to treat these complications.

"We found that delays or reductions in care for cardiovascular disease persisted after relatively long follow-up and even occurred for services used against life-threatening diseases," said Dr. Frank Wharam, director of Study at Harvard Medical School and Harvard Pilgrim Health. Boston Care Institute.

A growing proportion of Americans, including diabetics, have high deductible health insurance plans requiring them to shell out about $ 1,000 to $ 7,000 a year if they use care services report, note the researchers in Annals of Internal Medicine. However, studies to date have not made it clear how these additional costs could affect the use of health care by people with diabetes.

The study can not prove whether, or how, the costs could have influenced the time that patients waited for examinations, laboratory tests or necessary treatments.

But it's likely that the money played a role, because all the people in the study had diabetes with similar risks of cardiovascular complications, Wharam said via email.

"We can assume that diabetic patients' knowledge about the high cost of care and their desire to save money have led to these trends," said Wharam.

Between 2003 and 2012, all patients in the study had health insurance from a single major health insurance company in the United States, and their employers did not offer more than one insurance option per year.

People who opted for high-deductible diets were 6% less likely to seek care for the first major new symptom of complications during the study, such as chest or leg pain. They were also 9% less likely to have the first diagnostic test they needed and 9% less likely to have surgery to treat these complications.

Compared to those who remained in low-deductible diets throughout the study, health care costs increased from 43% to 53% per year on average.

The research team was unable to determine why patients may have chosen to wait for the care they needed, which made it impossible to prove that the increased costs were partly or wholly responsible. authors.

"I'm not aware of any rigorous study of motivations and thought processes, but the economic model would suggest that someone who should pay more would delay the management of mild symptoms that may go away." Themselves, "said Mark Pauly of the Wharton School and the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.

"Someone whose care is free because the insurance is covered would be more likely to do it from the first symptom," said Pauly, author of an accompanying editorial, by email.

SOURCE: bit.ly/2qUsCyw and bit.ly/2Q6vTcf Annals of Internal Medicine, online November 19, 2018.