High-Deductible Insurance and Delay in Care for the Macrovascular Complications of Diabetes

Abstract

Background: Little is known about the long-term effects of high-deductible insurance on care for chronic medical conditions. Objective: To determine whether a transition from low-deductible to high-deductible insurance is associated with delays in the medical care for macrovascular complications of diabetes. Design: Observational comparison of matched groups. Setting: A large national health insurer during 2003-2012. Participants: The intervention group included 33,957 enrollees with diabetes who were continuously enrolled in low-deductible (<USD500) insurance plans during a baseline year followed by up to 4 years in high-deductible (≥USD1000) plans. The control group included 294,942 enrollees with diabetes who were in low-deductible plans and whose enrollment was contemporaneous with matched intervention group members. Intervention: Employer-mandated transition to a high-deductible insurance plan. Measurements: We determined how long it took for enrollees in each study group to seek care for their first major macrovascular symptom, to have their first major diagnostic test for macrovascular disease, and to have their first major procedure-based treatment. We then calculated the differences in months for the study groups to reach a midpoint event rate. Results: We did not find baseline differences between study groups. During follow-up, the delay for the high-deductible group was 1.5 months (95% CI: 0.8, 2.3) to first major symptom, 1.9 months (1.4, 2.3) to first major diagnostic test, and 3.1 (0.5, 5.8) months to first procedure-based treatment. Limitation: The study did not examine health outcomes. Conclusion: Among enrollees with diabetes, mandated enrollment in a high-deductible insurance plan was associated with delays in seeking care for first major symptoms of macrovascular disease, first diagnostic testing, and first procedure-based treatment. Primary Funding Source: This work was supported by grant R01DK100304 from the National Institute of Diabetes and Digestive and Kidney Diseases.