Low-Income Patients with Diabetes Underinsured with High-Deductible Health Plans

FOR IMMEDIATE RELEASE: Friday, December 23, 2016

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WASHINGTON, DC — Falling income, greater incidence of diabetes and higher out-of-pocket expenses in high-deductible health plans have formed a perfect storm for reduced use of needed health care among people with diabetes, according to research by the Robert Graham Center.

Researcher Anuradha Jetty, MPH, and her colleagues looked at the impact of insurance plans’ deductible amounts on the low- and high-income patients who have diabetes. They did so by comparing low-income and high-income patients’ demographic characteristics, use of medical services, diabetic care and health status between the two income groups.

“Private insurance with deductibles substantially and problematically reduces medical service use for lower income high-deductible insured diabetic respondents, who are more likely to report forgoing needed medical services,” Jetty and her colleagues conclude.

Their results were published in “Among Low-Income Diabetic Respondents High Deductible Versus No Deductible Insurance Sharply Reduces Medical Service Use(care.diabetesjournals.org),” in Diabetes Care.

Jetty and her colleagues found that, compared to privately insured diabetic patients with no deductibles, privately insured low-income diabetic patients with a high deductible reduced their primary care visits by 42 percent, their checkup visits by 65 percent and their specialty visits by 86 percent. A similar but smaller effect was seen among low-income patients with low deductibles. They cut back on seeking primary care services by 27 percent, on getting checkups by 39 percent and seeking specialists by 77 percent. By contrast, higher income, low-deductible diabetic patients reported decreases in specialty care by 28 percent and emergency department visits by 37 percent.

The findings are significant because multiple studies have demonstrated that reduced service for diabetes can lead to more complications, more intensive medical interventions, higher long-term costs and reduced quality of life.

Much of these findings can be linked to a combination of factors: stagnant or reduced real income for people living at less than $48,500 for a family of four; health care inflation that has raised family coverage for employer-based insurance to $17,545 in 2015; and the growing enrollment in high-deductible health plans, which have lower premiums but much higher out-of-pocket costs.

“For many diabetic patients the major out-of-pocket cost is the rapidly inflating cost of diabetic medications,” Jetty and her colleagues write. “From 2010-2015, the cost of popular brand name diabetic drugs more than doubled; and still, no generic insulin is available. Unsurprisingly, medical debt amongst insured patients is most common for patients of low-income and medical debt itself is a deterrent to medical service use.”

As a result, patients with medical debt are 2.5 times more likely to delay or avoid care compared to those without debt, according to Jetty.

“Not only is their fiscal well-being compromised by premiums, deductibles, and out-of-pocket costs, but patients’ family members also forgo medical care,” she writes. “Policy changes to encourage value based insurance without copayments for disease-related medication or ambulatory care, or, income-related cost sharing for treatable chronic disease related care such as diabetes should be implemented. Without such modifications, high deductible HDHP for low-income diabetic patients is problematical mandated insurance.”

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About the Robert Graham Center

The Robert Graham Center for Policy Studies in Family Medicine and Primary Care works to improve individual and population health by enhancing the delivery of primary care. The Center staff generates and analyzes evidence that brings a family medicine and primary care perspective to health policy deliberations at local, state, and national levels.

Founded in 1999, the Robert Graham Center is an independent research unit affiliated with the American Academy of Family Physicians (AAFP). The information and opinions contained in research from the Center do not necessarily reflect the views or policy of the AAFP.