High-deductible health plans are moving health outcomes in the wrong direction

As the number of Americans enrolled in high-deductible health plans continues to grow, recent studies conducted by researchers at some of the nation's top hospitals and medical schools have linked HDHPs with worse health outcomes, less spending on preventive care, and higher utilization rates of emergency rooms.

High-deductible health plans are defined as plans that meet the minimum deductible amount required for health savings account eligibility — $1,400 for an individual and $2,800 for a family in 2021.

In 2021, more than 56 percent of private-sector Americans were enrolled in a HDHP — the highest state is Maine (76 percent) while the lowest is Hawaii (11.6 percent).

Conclusions of five HDHP studies recently reported by Becker's:

1. A study published Jan. 20 in JAMA Network Open found that diabetic patients who were forced to enroll in a HDHP by their employer face a higher risk of acute diabetes complications compared to those enrolled in traditional health plans. HDHPs increased the risk of needing to visit the emergency room or hospital for severe hyperglycemia by 25 percent, and each year of enrollment increased the risk by 5 percent.

2. A study presented Nov. 29 by Boston Medical Center researchers to the Radiological Society of North America found that over 21 percent of women surveyed said they would not seek an additional screening after abnormal findings on a mammogram if they knew they had to pay a deductible. 

3. A study published Oct. 5 in the American Journal of Managed Care found that individuals with HDHPs were 6.6 percent less likely to receive treatment for substance use disorders than those with traditional health plans.

4. An observational study presented in June by Harvard Medical School researchers at the American Society of Clinical Oncology's annual meeting linked HDHPs with a 4.6 month delay in the detection of metastatic cancer compared to individuals enrolled in a low-deductible plan.

5. A study published May 9 in the American Journal of Managed Care found that when HDHPs are present, employees making less than $75,000 annually spend more on emergency care and have higher acute care utilization rates, and they have lower rates of primary care spending compared with high-salary employees.

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