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-------- Original Message --------
Subject: qotd: Low-socioeconomic patients with high-deductibles receive
less high-severity emergency care
Date: Tue, 6 Aug 2013 06:47:57 -0700
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>
Health Affairs
August 2013
Low-Socioeconomic-Status Enrollees In High-Deductible Plans Reduced
High-Severity Emergency Care
By J. Frank Wharam, Fang Zhang, Bruce E. Landon, Stephen B. Soumerai and
Dennis Ross-Degnan
Abstract
One-third of US workers now have high-deductible health plans, and those
numbers are expected to grow in 2014 as implementation of the Affordable
Care Act continues. There is concern that high-deductible health plans
might cause enrollees of low socioeconomic status to forgo emergency
care as a result of burdensome out-of-pocket costs. We analyzed
emergency department (ED) visits and hospitalizations over two years
among enrollees insured in high-deductible plans through small employers
in Massachusetts. We found that plan members of low socioeconomic status
experienced 25–30 percent reductions in high-severity ED visits over
both years, while hospitalizations declined by 23 percent in year 1 but
rose again in year 2. Similar trends were not found among
high-deductible plan members of high socioeconomic status. Our findings
suggest that plan members of low socioeconomic status at small firms
responded inappropriately to high-deductible plans and that initial
reductions in high-severity ED visits might have increased the need for
subsequent hospitalizations. Policy makers and employers should consider
proactive strategies to educate high-deductible plan members about their
benefit structures or identify members at higher risk of avoiding needed
care. They should also consider implementing means-based deductibles.
http://content.healthaffairs.org/content/32/8/1398.abstract
Comment: People of low-socioeconomic status who have high-deductible
health plans have 25 to 30 percent fewer emergency department visits for
high-severity medical conditions - conditions with a high probability of
needing ED-level care within twelve hours. That can't be good.
Since similar trends were not found in people of high-socioeconomic
status, the authors suggest that deductibles should be means-based -
lower deductibles for those of low-socioeconomic status. But that would
add more administrative complexity to our system already overburdened
with administrative excesses.
The purpose of the deductibles is to reduce health care spending, but we
don't want to do that by not taking care of individuals with
high-severity medical conditions. It would be far more efficient to
simply eliminate deductibles for everyone and use better,
patient-friendly methods of controlling spending. That's what single
payer is all about - people getting the health care they need while
making it affordable for everyone.
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