Affiliation:
1. Department of Adult and Family Medicine, Kaiser Permanente, Santa Clara, CA
2. Kaiser Permanente Division of Research, Oakland, CA
Abstract
OBJECTIVEHigh-deductible health plans (HDHPs) are increasingly more common but can be challenging for patients to navigate and may negatively affect care engagement for chronic conditions such as type 2 diabetes. We sought to understand how higher out-of-pocket costs affect participation in provider visits, medication adherence, and routine monitoring by patients with type 2 diabetes with an HDHP.RESEARCH DESIGN AND METHODSIn a retrospective cohort of 19,379 Kaiser Permanente Northern California patients with type 2 diabetes (age 18–64 years), 6,801 patients with an HDHP were compared with those with a no-deductible plan using propensity score matching. We evaluated the number of telephone and office visits with primary care, oral diabetic medication adherence, and rates of HbA1c testing, blood pressure monitoring, and retinopathy screening.RESULTSPatients with an HDHP had fewer primary care office visits compared with patients with no deductible (4.25 vs. 4.85 visits per person; P < 0.001), less retinopathy screening (49.9% vs. 53.3%; P < 0.001), and fewer A1c and blood pressure measurements (46.7% vs. 51.4%; P < 0.001 and 93.2% vs. 94.4%; P = 0.004, respectively) compared with the control group. Medication adherence was not significantly different between patients with an HDHP and those with no deductible (57.4% vs. 58.6%; P = 0.234).CONCLUSIONSHDHPs seem to be a barrier for patients with type 2 diabetes and reduce care participation in both visits with out-of-pocket costs and preventive care without out-of-pocket costs, possibly because of the increased complexity of cost sharing under an HDHP, potentially leading to decreased monitoring of important clinical measurements.
Publisher
American Diabetes Association
Subject
Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine
Reference36 articles.
1. National health expenditure projections, 2015-25: economy, prices, and aging expected to shape spending and enrollment;Keehan;Health Aff (Millwood),2016
2. Section 8: high-deductible health plans with savings option. In ClaxtonG, RaeM, LongM, DamicoA, FosterG, WhitmoreH. Kaiser Family Foundation and Health Research & Educational Trust Employer Health Benefits Survey. Accessed 5 August 2020. Available from https://www.kff.org/report-section/ehbs-2017-section-8-high-deductible-health-plans-with-savings-option/
3. Cohen RA , MartinezME, ZammittiEP. Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–March 2018. Accessed 5 August 2020. Available from https://www.cdc.gov/nchs/data/nhis/earlyrelease/Insur201808.pdf
4. Do “consumer-directed” health plans bend the cost curve over time?;Haviland;J Health Econ,2016
5. Health savings accounts—the ownership society in health care;Robinson;N Engl J Med,2005
Cited by
9 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献