MedicalResearch.com Interview with:
J. Franklin Wharam MD MPH
Associate Professor, Harvard Medical School
Director, Division of Health Policy and Insurance Research
DPM Site Director, Harvard Medical School General Internal Medicine Fellowship
Harvard Medical School and HPHCI Department of Population Medicine
MedicalResearch.com: What is the background for this study?
Response: High-deductible health plans have been increasing over the last decade and are now the most common form of private health insurance. It also appears that high-deductible plans associated with health savings accounts will be the centerpiece of the new presidential administration’s plan to replace the Affordable Care Act.
In high-deductible plans, members pay more out-of-pocket for services such as specialist visits, emergency department visits, and hospitalizations, so patients might delay or skip needed care due to high costs.
The theory behind high-deductible insurance is that patients paying out-of-pocket for health care, sometimes called having “skin in the game,” will consider their health care use more carefully than if they are spending “someone else’s money.” It is hoped that this will motivate patients to receive only care they truly need rather than services that have not been shown to improve health, such as an MRI for uncomplicated low back pain. However, it could be challenging for patients to make this distinction, and those facing a high burden of costs might decide to take a chance and delay or skip care even if they think it would be beneficial.
We decided to examine how high-deductible health plans affect people with diabetes because these patients often need frequent, expensive health care services and no studies have examined adverse outcomes among chronically ill patients in high-deductible plans. Skipping or delaying needed diabetes care could cause patients to be sicker in the future and could therefore increase the need for more expensive or higher acuity care.
This study focused on whether high-deductible enrollment among people with diabetes changed outpatient visits and routine disease monitoring, and effects of such potential changes.