Diabetes workers who switch to high-level healthcare plans that require more than a pocket payment can be more likely than those who remain in low-level plans to postpone the required examinations, according to the US study.
People with diabetes are at risk for life-threatening diseases of blood vessels. Left untreated, these conditions can lead to complications such as heart attack, stroke, and amputation.
For the study, the researchers examined data for nearly 34,000 people with diabetes who initially had health-sponsored health plans sponsored by employers with a $ 500 or less franchise – but then their employers switched only to plans with deductibles of $ 1,000 or more. The study team also looked at a comparison group of nearly 295,000 diabetic workers who continuously have deductions of US $ 500 or less.
Before the first group to switch to higher hormonal health plans, there were no significant differences between the groups on how long patients waited to care for complications that could be life-threatening without timely treatment, the study showed.
But over the four years since some employers switched to offering only high-deductive plans, patients on these plans waited an average of 1.5 months longer than people in low-defensive plans to look after new symptoms of cardiovascular complications associated with diabetes, 1.9 months longer for diagnostic tests and 3.1 months longer for medical procedures to treat these complications.
"We found that delays or reductions in caring for cardiovascular disease persist during relatively long monitoring and occur even for services that are used for life-threatening conditions," said study leader Dr. Frank Warham of Harvard Medical School and Harvard Pilgrim Health Care Institute in Boston.
The rising percentage of Americans, including people with diabetes, have high-deductible health insurance plans and require them to pay around $ 7,000 to $ 7,000 a year if they use health services, researchers in the Annals of Internal Medicine said. But to date, studies did not offer a clear picture of how this added value can affect the use of health care for people with diabetes.
The study can not prove whether or how costs could have influenced how long patients waited to receive the necessary exams, laboratory tests or treatments.
But it is likely that money played a role because everyone in the study had diabetes with similar risks of cardiovascular complications, said Varam by email.
"We can speculate that the knowledge of diabetes patients for the high cost of care and the desire to save money has led to these models," said Waram.
All patients in the study had health insurance sponsored by employers provided by a major health insurance company in the United States between 2003 and 2012, and their employers offered no more than one insurance option in any given year.
People who have switched to high-deductible plans, 6% less likely to seek care for the first new major symptom of complications during the study, such as chest or leg pain. They also had a 9 per cent less chance of getting the first diagnostic test they needed, and 9 per cent less likely to receive procedures to treat these complications.
Compared with people who remained in low-level plans during the study, those who switched to plans with larger deductions, their health costs rose by an average of 43 to 53 percent per year.
The research team could not confirm why patients may have chosen to wait for the care needed, which makes it impossible to prove that the increased costs were partially or completely responsible, the authors note.
"I am not aware of any rigorous studies that are questioning the motives and thought processes, but the economic model would suggest that the person who will have to pay more will delay the care of light symptoms that could be resolved by themselves," said Marc Pauli of the Wharton School and the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.
"Someone whose care is free, because the insurance covers it, it would be more likely to look after the first sign of the symptom," said Paul, author of the Associate Editor, by e-mail.
SOURCE: https://bit.ly/2qUsCyw and https://bit.ly/2Q6vTcf Annals of Internal Medicine, online November 19, 2018.