- Chronic obstructive pulmonary disease patients enrolled in high-deductible health plans are more likely to face financial strain and barriers to care, along with more ER visits and hospitalizations than those with traditional plans, according to research published Thursday in Annals of the American Thoracic Society.
- Nearly 29% of patients with HDHPs reported a problem accessing care, including not being able to afford a specialist visit or skipping medication to save money. That compares to 16% among those with regular plans. They were also more likely to report high out-of-pocket costs and medical bill problems.
- About a third of high-deductible patients had one or more emergency department visits in the previous year compared to 26% of the other group. HDHP users also had a higher average number of hospitalizations. Outpatient visits, however, were similar for both groups.
HDHPs have become more prevalent in recent years and got a boost recently from the Trump administration. The number of people with such plans increased from about 25% of the privately insured under 65 in 2010 to 43% this year, according to the National Center for Health Statistics' February report.
The IRS issued a rule in July that would allow those plans to cover certain services and medications as preventive care for people with chronic conditions like COPD. That followed an executive order to boost other coverage options for HDHPs, in particular allowing the use of health savings account funds to cover direct primary care.
Plans with high deductibles are meant to push consumers to think more carefully about the healthcare services they use, including whether the treatment is necessary and whether it could be received in a less expensive setting.
That information is notoriously difficult for patients to find and understand, however, and research has shown people in HDHPs are more likely to be unsatisfied with their plans and say they have difficulty affording care.
The researchers behind the latest study noted the expansion of HDHPs with caution in light of their findings. "Our results suggest that such policy — or similar proposals that would raise out-of-pocket costs or give individuals more 'skin in the game' — could harm patients with COPD," they wrote. "Conversely, removing financial barriers to care might benefit them, and patients with other chronic disease."
Lead author Adam Gaffney of Harvard Medical School went further in a statement accompanying the article's publication, saying the "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."
The researchers studied more than 2,000 privately insured adults with COPD using the National Health Interview Survey. More than 13 million Americans have been diagnosed with the condition.