COPD patients with high insurance deductibles more likely to skip care

Patients with chronic obstructive pulmonary disease who were enrolled in private high-deductible health plans more frequently reported putting off or skipping care and ending up in the hospital or emergency department than patients without high deductibles, according to a new study.

Those with high deductibles were also more likely to report struggling to pay monthly bills and report family out-of-pocket healthcare costs that exceeded $5,000 in a year, Harvard Medical School researchers wrote in the study published Thursday in the Annals of the American Thoracic Society.

“Our study shows that 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,” lead author Dr. Adam Gaffney, an instructor in medicine at Harvard Medical School, said in a statement.

The study adds to a growing body of research demonstrating how high-deductible plans may reduce necessary care. The number of people under 65 years old with private health insurance enrolled in a high-deductible plan grew to 46% in the first half of 2018 from about 25% in 2010, according to the National Center for Health Statistics. Medical treatment is available to alleviate symptoms and improve outcomes for the 13 million Americans with COPD, but patients have to be able to afford them, Harvard researchers wrote.

By analyzing National Center for Health Statistics’ survey data from 2011 to 2017, the researchers found that almost a quarter—24%—of COPD patients with high deductibles said they delayed care because of the cost, compared with 12% of patients in plans without high deductibles, characterized in the study as “traditional” plans. About 15% of high-deductible patients did not obtain care because of the cost, while just 7% of patients in traditional plans skipped care.

About a fifth of patients with high deductibles reported they couldn’t afford their medications and 18% skipped doses to save money. That compares with 13% of traditional plan members who reported they couldn’t afford drugs and 11% who skipped doses.

While both categories of patients had similar rates of physician office visits, high-deductible enrollees ended up in the hospital or ED more often. A third of patients with a high deductible reported having one or more ED visits in the previous year compared with 26% of patients in a traditional plan. And 17% of high-deductible members visited the hospital in the past year, compared with 12% of traditional plan members.

According to the study, 21% of COPD patients in high-deductible plans had family out-of-pocket medical spending of more than $5,000, compared with 8% of patients with traditional plans. Patients with high-deductibles plans were also more likely to worry about paying their monthly bills or the cost of a serious illness or accident.

Researchers used the National Center for Health Statistics’ annual National Health Interview Survey data to analyze 2,137 privately insured adults with self-reported COPD ages 40 to 64 during the study period. Among those, 803 had a high-deductible plan and 1,334 had a traditional plan without a high deductible. High-deductibles were defined using the Internal Revenue Service-specified thresholds. In 2017, such plans had a minimum annual deductible of $1,300 for individuals and $2,600 for families. Researchers said the study has limitations because it is based on self-reported survey data.

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