High Deductibles May Mean Poorer Diabetes Care
For Americans with diabetes, high-deductible health insurance plans may lead to delays in diagnosing and treating dangerous blood vessel diseases, a new study suggests.
"People with diabetes in high-deductible health insurance plans compared to people with diabetes without high-deductible health insurance had delays in care for macrovascular complications of a month to three months," said the study's lead author, Dr. Frank Wharam. He's director of the Harvard Pilgrim Health Care Institute's division of health policy and insurance research.
Macrovascular complications are problems related to large blood vessels, such as those leading to the heart and brain. These include heart disease, stroke and peripheral artery disease -- a condition that affects blood supply to your limbs.
People with diabetes have a greater risk of macrovascular complications, and 70 percent of deaths in people with diabetes are linked to these complications, the Harvard study authors said.
A high-deductible health insurance plan has a deductible of $1,000 or more per year, according to the study. That means someone must pay at least $1,000 of their health care costs before their insurance starts paying for any health care expenses. The researchers said that some plans have deductibles as high as $7,000 per person, per year.
Nearly half of Americans insured in employer-provided health care are enrolled in high-deductible health insurance plans, according to a new report from the U.S. Centers for Disease Control and Prevention.
And those high-deductible costs may keep people from seeking care, at least for a little while, the study found.
To see what effect deductibles had on care for those blood vessel diseases, the researchers reviewed data for up to four years on nearly 34,000 people with diabetes who previously had low-deductible ($500 or less a year) insurance and then had high-deductible insurance ($1,000 or more a year). The researchers compared them to a group of almost 300,000 people with diabetes who had low-deductible health insurance throughout the study period.
When the study began and both groups had low-deductible health insurance, the researchers saw no difference in how quickly patients received care for symptoms, diagnosis or treatment of macrovascular complications.
When members of the smaller group transitioned to the high-deductible insurance care, they delayed going to the doctor for their first symptom of macrovascular disease by 1.5 months. They waited almost two months for their first diagnostic test and just over three months for their first procedure-based treatment.
Wharam said his previous research has shown that a delay for certain problems could lead to serious complications. "If you have a skin infection and go to the doctor on day one, you could be walking out with a bottle of pills to treat the infection. If you wait till day seven, you could end up hospitalized," he explained.
Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City, said the study highlights shortcomings in insurance coverage in the United States.
"This study shows once more the problems we have in our health system. Deductibles are another barrier to treating diabetes and cardiovascular disease," said Zonszein, who wasn't involved with the study.
"Patients are benefitting less and less from insurance, and we continue to treat the complications of diabetes instead of paying for prevention," he said.
Wharam said if your employer offers you a choice, or you have options on your state's health care exchange, look closely at what your costs for each plan will be. He noted that people with diabetes often have a lot of health care costs. So it might make more sense to pay a higher monthly premium to lower your out-of-pocket costs from deductibles and copays. But it depends on your particular situation.
He also suggested seeing if your employer offers a health savings plan. These can help spread the cost of health care throughout the year.
Whatever your health care situation, Wharam said if you need care, you should get it. "If you have diabetes, our study shows there's a delay in care. It might be conscious or subconscious, but there's a delay. Patients should seek care [without regard to] the cost," he said.
Results of the study were published in the Nov. 20 issue of Annals of Internal Medicine.
The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about paying for diabetes care.
SOURCES: Frank Wharam, M.B., B.Ch., B.A.O., M.P.H., director, Division of Health Policy and Insurance Research, Harvard Pilgrim Health Care Institute, and associate professor, Harvard Medical School, Boston; Joel Zonszein, M.D., director, Clinical Diabetes Center, Montefiore Medical Center, New York City; Nov. 20, 2018, Annals of Internal Medicine
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