Delayed and Forgone Care for Families with Chronic Conditions in High-Deductible Health Plans
- 822 Downloads
High-deductible health plans (HDHPs) are an increasingly common strategy to contain health care costs. Individuals with chronic conditions are at particular risk for increased out-of-pocket costs in HDHPs and resulting cost-related underuse of essential health care.
To evaluate whether families with chronic conditions in HDHPs have higher rates of delayed or forgone care due to cost, compared with those in traditional health insurance plans.
This mail and phone survey used multiple logistic regression to compare family-level rates of reporting delayed/forgone care in HDHPs vs. traditional plans.
We selected families with children that had at least one member with a chronic condition. Families had employer-sponsored insurance in a Massachusetts health plan and >12 months of enrollment in an HDHP or a traditional plan.
The primary outcome was report of any delayed or forgone care due to cost (acute care, emergency department visits, chronic care, checkups, or tests) for adults or children during the prior 12 months.
Respondents included 208 families in HDHPs and 370 in traditional plans. Membership in an HDHP and lower income were each independently associated with higher probability of delayed/forgone care due to cost. For adult family members, the predicted probability of delayed/forgone care due to cost was higher in HDHPs than in traditional plans [40.0% vs 15.1% among families with incomes <400% of the federal poverty level (FPL) and 16.0% vs 4.8% among those with incomes ≥400% FPL]. Similar associations were observed for children.
Among families with chronic conditions, reporting of delayed/forgone care due to cost is higher for both adults and children in HDHPs than in traditional plans. Families with lower incomes are also at higher risk for delayed/forgone care.
KEY WORDShealth insurance deductible cost sharing utilization health policy
The authors thank Christopher Forrest, Bruce Landon, and Carol Cosenza for guidance in the design of the survey instrument; Christopher Forrest and Linda Dunbar for making the Chronic Condition Checklist available and assisting with its use; Irina Miroshnik for help with data collection and interpretation; and the team of research assistants for their help in conducting the survey.
This study was supported by the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization (HCFO) Initiative. Additional support for the survey was provided by the Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School. Dr Galbraith’s effort was supported in part by a K23 Mentored Career Development Award from NICHD (HD052742). Drs. Soumerai and Ross-Degnan are investigators in the HMO Research Network Center for Education and Research in Therapeutics and are supported by the Agency for Healthcare Research and Quality (grant no. U18HS010391). The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the funders.
An abstract based on this research was presented at the 2010 Pediatric Academic Societies Meeting in Vancouver, British Columbia, and at the 2010 AcademyHealth Annual Research Meeting in Boston, MA, as a poster.
Conflict of Interest
Dr. Galbraith has received support for a separate research project from the Harvard Pilgrim Health Care Foundation through a Faculty Grant.
- 2.Kaiser Family Foundation. Summary of New Health Reform Law. 2010; http://www.kff.org/healthreform/upload/8061.pdf. Accessed Dec 13, 2011.
- 5.Cohen R. Impact of Type of Insurance Plan on Access and Utilization of Health Care Services for Adults Aged 18–64 Years With Private Health Insurance: United States, 2007–2008: NCHS Data Brief No. 28;2010.Google Scholar
- 6.Fronstin P, Collins SR. Findings from the 2007 EBRI/Commonwealth Fund Consumerism in Health Survey. 2008. http://www.commonwealthfund.org/usr_doc/Fronstin_consumerism_survey_2007_issue_brief_FINAL.pdf?section=4039. Accessed Dec 13, 2011.
- 8.Dunbar L. Alternative Methods of Identifying Children with Special Health Care Needs: Implications for Medicaid Programs: University of Maryland; 2005.Google Scholar
- 9.Bethell C, Read D, Stein R, Blumberg S, Wells N, Newacheck P. Identifying children with special health care needs: development and evaluation of a short screening instrument. Ambul Pediatr. 2002:38-48.Google Scholar
- 16.Newhouse JP and the Insurance Experiment Group. Free for All? Lessons from the RAND Health Insurance Experiment. Cambridge: Harvard University Press; 1993.Google Scholar
- 18.Lieu T, Solomon J, Sabin J, Kullgren J, Hinrichsen V, Galbraith A. Consumer awareness and strategies among families with high-deductible health plans. J Gen Intern Med. 2010;25(3).Google Scholar
- 25.U.S. Department of Health & Human Services. Recommended Preventive Services. 2010; http://www.healthcare.gov/center/regulations/prevention/recommendations.html. Accessed Dec 13, 2011.
- 28.Cunningham PJ, Miller C, Cassil A. Living on the Edge: Health Care Expenses Strain Family Budgets. Research Brief No. 10: Center for Studying Health Systems Change; December 2008.Google Scholar
- 30.Tu HT, Cohen G. Financial and Health Burdens of Chronic Conditions Grow. Tracking Report No. 24. 2009. http://www.hschange.org/CONTENT/1049/1049.pdf. Accessed Dec 13, 2011.