In the Journals

High-, low-deductible plans linked to higher out-of-pocket spending among chronically ill adults

Americans with chronic conditions who had high- or low-deductible health insurance plans also had higher out-of-pocket spending and more frequent medical cost burdens, according to a research letter published in JAMA Internal Medicine.

“Privately insured Americans increasingly face heath plan deductibles, which can elevate exposure to financial risk and may lead to delayed or foregone care,” Joel E. Segel, PhD, from the department of health policy and administration at Pennsylvania State University, and Jeffrey T. Kullgren, MD, MS, MPH, from Veterans Affairs Ann Arbor Healthcare System, wrote. “It is unknown to what extent these deductibles increase financial risks and decrease the ability to afford care among Americans with chronic conditions who could be more vulnerable to such outcomes.”

To analyze these potential financial risks, researchers compared associations between private health plan deductibles and out-of-pocket spending, high medical cost burdens and affordability barriers among nonelderly adults with chronic conditions, including heart disease, diabetes, hypertension, joint disorders, mood disorders and multiple chronic conditions.

Using 2011-13 data, they analyzed Medical Expenditure Panel Survey participants aged 18 to 64 years who were always insured by one private health plan for the past year. Segel and Kellgren estimated associations between each deductible category and the annual probability of spending 10% or more of household income on health care or out-of-pocket premiums using multivariate logistic regression. They also reported unmet or delayed care due to cost.

Among the 17,177 individuals sampled, 4,120 had high-deductible plans and 7,767 had low-deductible plans. In addition, 7,639 participants (44.5%) had at least one chronic condition. Compared with no-deductible plans, investigators found that median out-of-pocket spending was $225 higher with high-deductible plans (95% CI, 165-285; P < .001) and $111 higher with low-deductible plans (95% CI, 72-150; P < .001). For those with hypertension, joint disorders, mood disorders and multiple chronic conditions, the researchers observed higher out-of-pocket spending with both high- and low-deductible plans compared with no-deductible plans. With high-deductible plans, the prevalence of high medical cost burdens was 7.5 percentage points greater (95% CI, 4.6-10.4; P < .001), while it was 3.7 percentage points greater with low-deductible plans (95% CI, 0.8 – 6.6; P < .01) compared with no-deductible plans.

“Although deductibles can be blunted for some low-income individuals in Marketplace plans, many privately insured individuals do not qualify for subsidies and face substantial financial risks,” Segel and Kullgren wrote. “As more privately insured Americans with chronic conditions face deductibles in employer-sponsored and Marketplace health plans, it will be crucial to monitor not only their [out-of-pocket] health care spending and ability to afford needed care, but also their health and financial outcomes.” by Savannah Demko

Disclosure: The researchers report support from the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service. Please see the full study for reported conflict of interest disclosures.

 

Americans with chronic conditions who had high- or low-deductible health insurance plans also had higher out-of-pocket spending and more frequent medical cost burdens, according to a research letter published in JAMA Internal Medicine.

“Privately insured Americans increasingly face heath plan deductibles, which can elevate exposure to financial risk and may lead to delayed or foregone care,” Joel E. Segel, PhD, from the department of health policy and administration at Pennsylvania State University, and Jeffrey T. Kullgren, MD, MS, MPH, from Veterans Affairs Ann Arbor Healthcare System, wrote. “It is unknown to what extent these deductibles increase financial risks and decrease the ability to afford care among Americans with chronic conditions who could be more vulnerable to such outcomes.”

To analyze these potential financial risks, researchers compared associations between private health plan deductibles and out-of-pocket spending, high medical cost burdens and affordability barriers among nonelderly adults with chronic conditions, including heart disease, diabetes, hypertension, joint disorders, mood disorders and multiple chronic conditions.

Using 2011-13 data, they analyzed Medical Expenditure Panel Survey participants aged 18 to 64 years who were always insured by one private health plan for the past year. Segel and Kellgren estimated associations between each deductible category and the annual probability of spending 10% or more of household income on health care or out-of-pocket premiums using multivariate logistic regression. They also reported unmet or delayed care due to cost.

Among the 17,177 individuals sampled, 4,120 had high-deductible plans and 7,767 had low-deductible plans. In addition, 7,639 participants (44.5%) had at least one chronic condition. Compared with no-deductible plans, investigators found that median out-of-pocket spending was $225 higher with high-deductible plans (95% CI, 165-285; P < .001) and $111 higher with low-deductible plans (95% CI, 72-150; P < .001). For those with hypertension, joint disorders, mood disorders and multiple chronic conditions, the researchers observed higher out-of-pocket spending with both high- and low-deductible plans compared with no-deductible plans. With high-deductible plans, the prevalence of high medical cost burdens was 7.5 percentage points greater (95% CI, 4.6-10.4; P < .001), while it was 3.7 percentage points greater with low-deductible plans (95% CI, 0.8 – 6.6; P < .01) compared with no-deductible plans.

“Although deductibles can be blunted for some low-income individuals in Marketplace plans, many privately insured individuals do not qualify for subsidies and face substantial financial risks,” Segel and Kullgren wrote. “As more privately insured Americans with chronic conditions face deductibles in employer-sponsored and Marketplace health plans, it will be crucial to monitor not only their [out-of-pocket] health care spending and ability to afford needed care, but also their health and financial outcomes.” by Savannah Demko

Disclosure: The researchers report support from the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service. Please see the full study for reported conflict of interest disclosures.