Researchers matched people in both groups according to patient-specific demographic and clinical characteristics and employer characteristics (such as the total number of employees) to ensure similarity. They examined whether switching to a high-deductible health plan changed employees' use of the ER for chest pain during the first year (the low-deductible year) compared to the second year (the high-deductible year). They also compared changes in annual patient outcomes from year one to year two between the high-deductible health plan group and the matched control group (those with low-deductible plan for two consecutive years).
Researchers found:
Switching to a high-deductible health plan was associated with a 4% reduction in ER visits for chest pain.
Enrollment in a high-deductible health plan was associated with an 11% decrease in ER visits for chest pain leading to hospitalization.
Among low-income patients, those who had high-deductible health plans were nearly one-third more likely to have a heart attack during a subsequent hospitalization 30 days after their initial ER visit for chest pain.
"People with higher deductibles delay treatment and are sicker when they show up in the ER for chest pain," Chou said. "When people with low-incomes are switched to high deductible plans, they are disproportionately impacted financially and so is their health."
Each year, up to 7 million people are cared for in an ER for chest pain. "These findings underscore the consequences associated with the affordability of health insurance and health expenses, especially for patients with chest pain, one of the most common reasons for ER visits," Chou noted.
"Cost is a real factor for patient outcomes," Chou said. "Clinicians need to consider actively including cost in our discussions with patients and in shared decision-making. Insurers and employers need to consider how they will manage high-deductible plans going forward - particularly given the health impact on their employees."
A limitation of the study is the inherent bias created by using an administrative dataset. However, the study design (interrupted time-series framework and matching) helped minimize these limitations.
Co-authors are Arthur S. Hong, M.D., M.P.H.; Scott G. Weiner, M.D., M.P.H.; and J. Frank Wharam, M.B.B.Ch., M.P.H. No funding sources are listed by the authors.
About the American Heart Association
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