Tuesday, August 27, 2013

Fwd: qotd: High-deductibles cause men to avoid ED use for high-severity conditions

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-------- Original Message --------
Subject: qotd: High-deductibles cause men to avoid ED use for
high-severity conditions
Date: Tue, 27 Aug 2013 10:53:58 -0700
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>

Medical Care (APHA)
August 2013
The Impact of High-deductible Health Plans on Men and Women: An Analysis
of Emergency Department Care
By Kozhimannil, Katy B. PhD, MPA; Law, Michael R. PhD, MSc;
Blauer-Peterson, Cori MPH; Zhang, Fang PhD; Wharam, James Frank MB, BCh,


Background: Prior studies show that men are more likely than women to
defer essential care. Enrollment in high-deductible health plans (HDHPs)
could exacerbate this tendency, but sex-specific responses to HDHPs have
not been assessed. We measured the impact of an HDHP separately for men
and women.

Methods: Controlled longitudinal difference-in-differences analysis of
low, intermediate, and high severity emergency department (ED) visits
and hospitalizations among 6007 men and 6530 women for 1 year before and
up to 2 years after their employers mandated a switch from a traditional
health maintenance organization plan to an HDHP, compared with
contemporaneous controls (18,433 men and 19,178 women) who remained in
an health maintenance organization plan.

Results: In the year following transition to an HDHP, men substantially
reduced ED visits at all severity levels relative to controls (changes
in low, intermediate, and high severity visits of −21.5% [−37.9 to
−5.2], −21.6% [−37.4 to −5.7], and −34.4% [−62.1 to −6.7],
respectively). Female HDHP members selectively reduced low severity
emergency visits (−26.9% [−40.8 to −13.0]) while preserving intermediate
and high severity visits. Male HDHP members also experienced a 24.2%
[−45.3 to −3.1] relative decline in hospitalizations in year 1, followed
by a 30.1% [2.1 to 58.1] relative increase in hospitalizations between
years 1 and 2.

Conclusions: Initial across-the-board reductions in ED and hospital care
followed by increased hospitalizations imply that men may have foregone
needed care following an HDHP transition. Clinicians caring for patients
with HDHPs should be aware of sex differences in response to benefit design.


Comment: One of the most important changes in health care financing
taking place today is the tremendous surge in the use of high-deductible
health plans. This is yet one more study that shows that we should
question the wisdom of this policy intervention.

Males whose employers switched them from a traditional HMO to a
high-deductible health plan reduced their use of emergency department
high-severity visits by 34 percent. That is, they did not go to the
emergency department when the severity of their condition clearly
warranted it. That was followed a year later by a 30 percent increase in
hospitalizations. Lead author Katy Kozhimannil stated, "The trends
suggest that men might have put off needed care after their deductible
went up, leading to more severe illness requiring hospital care later
on" (American Medical News, Aug. 26).

High-deductible health plans not only cause financial hardship, they
also maim and kill people. And they aren't even necessary as a means to
control spending. We can control costs more effectively and far more
humanely through a publicly-administered single payer program that
provides first-dollar coverage.

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