AHRQ, Author Interviews, Cost of Health Care, JAMA / 09.10.2018
High Deductible Plans Hit Chronically Ill Low-Income Patients Hardest
MedicalResearch.com Interview with:
[caption id="attachment_45155" align="alignleft" width="133"]
Dr. Abdus[/caption]
Salam Abdus, PhD
Division of Research and Modeling,
Center for Financing, Access, and Cost Trends,
Agency for Healthcare Research and Quality
Department of Health and Human Services
Rockville, Maryland
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: High deductible health plans are more prevalent than ever.
Previous research showed that adults in low-income families or with chronic conditions are more likely to face high financial burdens when they are enrolled in high-deductible health plans, compared to adults in higher income families or healthier adults.
In this study we examined the financial burden of high-deductible health plans among adults who are both low income and chronically ill. We used AHRQ’s Medical Expenditure Panel Survey Household Component (MEPS-HC) data from 2011 to 2015 to study the prevalence of high out-of-pocket health care spending burden of high deductible health plans among adults enrolled in employer-sponsored insurance. We included family out-of-pocket spending on premiums and health care services.
We found that among adults who had family income below 250% of Federal Poverty Level (FPL), had multiple chronic conditions, and were enrolled in high-deductible health plans, almost half (46.9%) had financial family out-of-pocket health care burden exceeding 20 percent of family disposable income.
Dr. Abdus[/caption]
Salam Abdus, PhD
Division of Research and Modeling,
Center for Financing, Access, and Cost Trends,
Agency for Healthcare Research and Quality
Department of Health and Human Services
Rockville, Maryland
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: High deductible health plans are more prevalent than ever.
Previous research showed that adults in low-income families or with chronic conditions are more likely to face high financial burdens when they are enrolled in high-deductible health plans, compared to adults in higher income families or healthier adults.
In this study we examined the financial burden of high-deductible health plans among adults who are both low income and chronically ill. We used AHRQ’s Medical Expenditure Panel Survey Household Component (MEPS-HC) data from 2011 to 2015 to study the prevalence of high out-of-pocket health care spending burden of high deductible health plans among adults enrolled in employer-sponsored insurance. We included family out-of-pocket spending on premiums and health care services.
We found that among adults who had family income below 250% of Federal Poverty Level (FPL), had multiple chronic conditions, and were enrolled in high-deductible health plans, almost half (46.9%) had financial family out-of-pocket health care burden exceeding 20 percent of family disposable income.








![MedicalResearch.com Interview with: Gili Regev-Yochay, MD, Lead author Director of the Infection Prevention & Control Unit Sheba Medical Center Tel HaShomer, Israel. MedicalResearch.com: What is the background for this study? Response: CPE (Carbapenemase producing Enterobacteriaceae) is endemic in Israel. In our ICU we had a prolonged CPE outbreak with one particular bacteria, which is not that common (OXA-48 producing-Serratia marcescens). Enhancing our regular control measures (hand hygiene, increased cleaning etc..) did not contain the outbreak. MedicalResearch.com: What are the main findings? Response: The outbreak source were the sink-traps in nearly all the patient rooms, which were contaminated with this same bacteria. Once we understood that this was the source we took two measures: 1) Sink decontamination efforts, including intensive chlorine washes of the drainage and water system, replacement of all sink-traps, acetic acid treatment and more, all these efforts were only partially and only temporarily successful. So that even today, after a year of such efforts and a period in which we didn't have any patients with this infection, the drainage system is still contaminated with these bugs and they grow in the sink-traps and can be found in the sink outlets. 2) The second measure we took was an educational intervention, where we engaged the ICU team through workshops to the issue of the contaminated sinks and together enforced strict "sink-use guidelines" (sinks are to be used ONLY for hand washing, prohibiting placement of any materials near the sinks, etc.). Using these two measure the outbreak was fully contained. To date, nearly 1.5 years since the last outbreak case, we did not have any further infections in our ICU patients with this bug. MedicalResearch.com: What should readers take away from your report? Response: Sink-traps and drainage systems can be a major source of CPE transmission. While traditionally CPE outbreaks were attributed to patient-to patient transmission, the environment and particularly water and drainage system appears to play a major role. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: There is urgent need to find a technological solution for drainage system contaminations. While some have suggested to get rid of sinks in ICU this is probably not realistic in the era of emerging Clostridium infections (where washing hands, and not only alcohol rubs are needed). Citation: Gili Regev-Yochay, Gill Smollan, Ilana Tal, Nani Pinas Zade, Yael Haviv, Valery Nudelman, Ohad Gal-Mor, Hanaa Jaber, Eyal Zimlichman, Nati Keller, Galia Rahav. Sink traps as the source of transmission of OXA-48–producing Serratia marcescens in an intensive care unit. Infection Control & Hospital Epidemiology, 2018; 1 DOI: 1017/ice.2018.235 [wysija_form id="3"] [last-modified] The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.](https://medicalresearch.com/wp-content/uploads/sink-200x150.jpg)









