High-Deductible Health Plans Linked With Financial Strain, More Frequent ED Visits for Patients With COPD

Enrollment in a high-deductible health plan (HDHP) was shown to be associated with cost-related barriers to care, financial strain, and more frequent emergency department (ED) visits and hospitalizations for patients with chronic obstructive pulmonary disease (COPD), according to a study published last week in the Annals of the American Thoracic Society.

For patients with COPD, effective medical treatment can improve quality of life and help patients avoid exacerbations within communities. The prevalence of HDHP plans have risen in recent years, with the proportion of privately insured patients aged under 65 years having the plan being 43% this past year, compared with 25% in 2010. As the authors noted that HDHPs have the potential to increase exposure to medical costs, and additionally compromise healthcare access and financial well-being for patients with COPD, they sought to assess the effect of HDHPs on patient care.

Researchers examined the association of HDHPs with healthcare access, utilization, and financial strain in patients with COPD. Data was derived from a National Health Interview Survey (NHIS) conducted between 2011-2017, which used Internal Revenue Service-specified thresholds to classify health plans as “high” or “traditional” deductible coverage, on privately insured adults aged 40-64 years with COPD. Analyses were stratified by high versus low deductible care, in which patients with HDHP coverage (n=803) were compared with individuals with a traditional plan (n=1334).

Study results exhibited a stark association between patients with COPD enrolled in a HDHP and multiple indicators of access to care, financial strain, and healthcare utilization assessed in the NHIS.

In the cost-related impediments to care questions, patients enrolled in HDHP were increasingly more likely to be unable to see a specialist (HDHP: 10.2%, Traditional: 5.3%; adjusted difference of 5.1 percentage points [pp]; 95% CI, 2.2-8.0; P = .001) and more likely to skip doses of their medication to save money (HDHP: 18.4%, Traditional: 10.7%; adjusted difference of 6.3 pp; 95% CI, 2.6-10.1; P = .001). Overall, patients enrolled in a HDHP reported higher rates of access to care problems and cost-related medication non-adherence outcomes (Access to care: 28.9% vs 16% of Traditional; Non-adherence: 30.1% vs 19.6% of Traditional).

Financial burden of care was higher among patients enrolled in HDHP as well. Individuals with HDHPs had a higher proportion of out-of-pocket medical spending greater than $5000 (21.3% vs 8%) and increased financial worries of paying their monthly bills (43.2% vs 33.7%). Utilization was found to be similar among both groups, but those with HDHPs had more ED visits and hospital utilization. Individuals with HDHPs were more likely to be hospitalized in the past year (17.1% vs 11.8%; adjusted p-value = .03), and more likely to have 1 or more ED visits in the previous year (33.3% vs 26.4%, adjusted p-value=.03).

Lead study author Adam Gaffney, MD, instructor in medicine at the Harvard Medical School, highlighted the study’s findings demonstrating impeded care for patients with COPD. “Patients with COPD who are privately insured, especially those with high deductibles, aren’t getting the care they need—with dangerous consequences for their health,” said Gaffney in a statement.

As healthcare costs inhibit access to care for patients with COPD, reforms in healthcare financing is necessary to promote the latest advances in treatment, noted the authors.

Reference

Gaffney A, White A, Hawks L, et al. High deductible health plans and healthcare access, use, and financial strain in those with COPD. [published online October 10, 2019]. Ann am thorac soc. doi: 10.1513/AnnalsATS.201905-400OC.