Frank Wharam, MD, MPH Department of Population Medicine Harvard Medical School and Harvard Pilgrim Healthcare Institute Boston, MA 02215

Are High Deductible Health Care Plans Associated With Worse Cardiac Outcomes?

MedicalResearch.com Interview with:

Frank Wharam, MD, MPH Department of Population Medicine Harvard Medical School and Harvard Pilgrim Healthcare Institute Boston, MA 02215

Dr. Wharam

Frank Wharam, MD, MPH
Department of Population Medicine
Harvard Medical School and Harvard Pilgrim Healthcare Institute
Boston, MA 02215

MedicalResearch.com: What is the background for this study?

Response:  There is substantial concern that high-deductible health plans increase people’s risk of major adverse health events such as heart attack and stroke. No studies have examined this question. This study examines the effects of a transition to a high-deductible health plan on the risk of major adverse cardiovascular outcomes (myocardial infarction and stroke).

The study group included individuals with risk factors for cardiovascular disease who were continuously enrolled in low-deductible (<$500) health plans during a baseline year followed by up to 4 years in high-deductible (≥$1000) plans after an employer-mandated switch. The matched control group included individuals with the same risk factors who were contemporaneously enrolled in low-deductible plans.  We examined time to first major adverse cardiovascular event, defined as myocardial infarction or stroke. 

MedicalResearch.com: What are the main findings?

Response: Investigators found that mandated enrollment in high-deductible health plans with typical value-based features was not associated with increased risk of major adverse cardiovascular events.

MedicalResearch.com: What should readers take away from your report? 

Response: High-deductible health plans with typical value-based features were not associated with increased risk of major adverse cardiovascular events.

Study findings do not necessarily apply to low-income patients, individuals with uncommonly high deductibles, newly insured patients, or people without cardiovascular risk factors. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: Although findings provide a measure of reassurance that HDHP enrollment was not associated with an appreciable increased risk of major adverse cardiovascular outcomes during 4 follow-up years, there are several caveats and recommendations. Most importantly, policymakers and employers should remain cautious in promoting HDHPs among low-income and other vulnerable patients given the potential for adverse financial and health outcomes that this study did not address. Research should also extend follow up time to better assess long-term outcomes and should examine whether people with HDHPs ultimately require more intensive workups and more advanced treatments for cardiovascular events. 

Citation:

Wharam JF, Wallace J, Zhang F, et al. Association Between Switching to a High-Deductible Health Plan and Major Cardiovascular Outcomes. JAMA Netw Open. 2020;3(7):e208939. doi:10.1001/jamanetworkopen.2020.8939 

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Last Modified: Jul 28, 2020 @ 10:23 am

 

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