Diabetic patients that were forced to enroll in a high-deductible health plan by their employer faced a higher risk of acute diabetes complications compared to those enrolled in traditional health plans, according to a study published Jan. 20 in JAMA Network Open.
The study included more than 42,000 patients who were enrolled in a non-HDHP for at least one year and who were required to switch to a HDHP by their employer. It also included more than 202,000 patients who did not switch plans.
The data was collected between 2010 and 2018 using claims data for commercially insured adults with diabetes that were covered by a single payer. The analysis was conducted between May 15, 2020 and November 3, 2022.
"Although HDHPs were created to lower insurance premiums and promote cost savings by limiting low value care, their implementation has adversely affected health outcomes in patients with diabetes," the authors wrote. "Individuals with low income and from minoritized racial and ethnic groups were especially susceptible to the detrimental outcomes of HDHP transition. Thus, HDHP enrollees may be rationing or foregoing necessary care, which is detrimental to their health and ultimately increases the morbidity, mortality, and costs associated with diabetes."
Four key takeaways:
- Switching to a HDHP did not increase the risk of needing to visit the emergency room or hospital for severe hypoglycemia, but each year of enrollment increased the risk by two percent.
- Switching to a HDHP 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 five percent.
- There was no significant risk with switching to a HDHP among race and ethnicity with either hyperglycemia-related ED or hospital visits or office visits, or between switching to a HDHP and income with respect to hyperglycemia-related ED or hospital visits.
- Switching to a HDHP was associated with a slightly higher risk of hyperglycemia-related office visits among those making at least $40,000 compared with those making less than $40,000.