Chronic conditions, such as diabetes, require management, care, and medications. When insurers create hurdles that directly or indirectly block access to care, those patients suffer.
And apparently, that’s exactly what’s happening across the United States right now as more patients elect high-deductible health plans (HDHPs).
Today, HDHPs are frequently pitched as a low-cost coverage option, but keeping patients from receiving care was baked into their origin story.
In an attempt to reduce healthcare costs, legislators began looking for ways to reduce “over-utilization” in the early 2000s. This is healthcare economics-speak for “reduce the amount of healthcare services people receive.”
One solution that gained traction was the creation of the high deductible health plan. Having a high deductible – meaning you pay more out of pocket before your insurance kicks in for care – was supposed to force consumers to have “more skin in the game” and avoid “expensive” healthcare services.
So, what actually happened? Rather than avoiding “expensive” or unnecessary healthcare, members of HDHPs became under-insured altogether – meaning relative to their income, their out-of-pocket costs, including deductibles and premiums, were too high to reasonably handle, and thus began avoiding healthcare altogether, despite paying for insurance to cover it.
Beyond paying for poor coverage that’s too expensive to use, the impact on members’ health can be serious.
According to a new study published by the Journal of the American Medical Association (JAMA) Network Open, diabetes patients who are moved into high-deductible health plans have a 25% increased chance that they will be rushed to the emergency room (ER) for severe hyperglycemia. And for each year that an employee with diabetes is enrolled in a HDHP their odds of going to the ER increase by 5%.
Why, you ask?
Researchers from the Mayo Clinic found that “HDHP enrollees may be rationing or foregoing necessary care, which is detrimental to their health and ultimately increases the morbidity, mortality, and costs associated with diabetes,” reports Fierce Healthcare.
HDHPs are a smart move for those with the means to afford them, or for those who are healthy and rarely need to go to the doctor or take prescription drugs. HDHPs are not right for people with chronic conditions — like diabetes — who need to go to the doctor frequently or who are on medications.
Here’s the rub: some employers only offer HDHPs.
The study states: “Because employees in HDHPs must first pay the cost for healthcare in full through their annual deductible—which can be $1,400 and up for an individual—those with chronic conditions such as diabetes might forego needed preventive and maintenance care that can be provided in a visit to a primary care physician, and which is much less costly than care in the ED.”
Individuals with low income or who come from minoritized racial and ethnic groups with diabetes are especially at risk if they are moved to a HDHP.
Before you blame employers, don’t forget that insurance companies have mastered increasing costs and avoiding coverage while preserving their own profits.
Because premiums keep going up. And while insurers will say the reason for high premiums is because of high hospital prices, if they’re pulling in more cash while spending less of that cash on claims, and making record profits…it really doesn’t seem like high hospital prices are to blame.
