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    High-deductible plan switch shows little effect on diabetes patients

    Most patients with diabetes who joined high-deductible health plans did not experience adverse outcomes related to diabetes, but acute diabetes complications increased among certain vulnerable subgroups, according to the results of a study published recently in JAMA Internal Medicine.

    “The clinical implication is that some vulnerable diabetes patients might end up sicker because of joining a high-deductible health plan,” J. Frank Wharam, MB, MCh, BAO, MPH, an internist and associate professor for Harvard Medical School and Harvard Pilgrim Health Care Institute, told Medical Economics. “Clinicians and their teams should pay special attention to, for example, low-income diabetes patients or diabetes patients with other chronic illnesses.”

    According to Wharam, little is known about how high-deductible health plans affect important health outcomes.

    “Many health interventions, such as medicines or medical devices, cannot be used until there is proof of safety and efficacy. Unfortunately, the same does not happen for health policies,” Wharam said. “High-deductible health plans have already been expanding quickly, and this expansion is expected to accelerate if the Affordable Care Act is replaced. As a society, we need to understand how high-deductible plans affect the health of patients with chronic illnesses.”

    To understand the effect of these plans on patients with diabetes, Wharam and collegaues conducted a study using data from a large national health insurer database from January 2003 to December 2012. The study included 12,084 people on a high-deductible health plan aged 12 to 64. Patients were enrolled for 1 year on a low-deductible plan before switching to a high-deductible plan after an employer-mandated switch.

    Overall, the increase in out-of-pocket spending was 49.4% for the entire study population compared with control patients who did not transition to a high-deductible plan; this increase was 51.7% for low-income patients, and 67.8% for patients were health savings account eligible.

    Next: The need for more tailored plans


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