Among Low-Income Respondents With Diabetes, High-Deductible Versus No-Deductible Insurance Sharply Reduces Medical Service Use

Abstract

OBJECTIVE To contrast the effect of private insurance and deductibles (by size) on medical service use, health status, and medical debt for adult respondents with diabetes with low and high incomes. RESEARCH DESIGN AND METHODS Using the 2011–2013 Medical Expenditure Panel Survey, bivariate and regression analyses were conducted to compare demographic characteristics, medical service use, diabetes care, and health status among privately insured adult respondents with diabetes, aged 18–64 years (N = 1,461) by lower (<200% of the federal poverty level) and higher (≥200% of the federal poverty level) income and deductible vs. no deductible (ND), low deductible ($1,000/$2,400) (LD), and high deductible (>$1,000/$2,400) (HD). The National Health Interview Survey 2012–2014 was used to analyze differences in medical debt and delayed/avoided needed care among adult respondents with diabetes (n = 4,058) by income. RESULTS Compared with privately insured respondents with diabetes with ND, privately insured lower-income respondents with diabetes with an LD report significant decreases in service use for primary care, checkups, and specialty visits (27%, 39%, and 77% lower, respectively), and respondents with an HD decrease use by 42%, 65%, and 86%, respectively. Higher-income respondents with an LD report significant decreases in specialty (28%) and emergency department (37%) visits. Diabetes care measures are similar by income and insurance; there were no changes in physical health status. Medical debt is similar by income, but deferred service use is two times greater for those indebted and with lower income. CONCLUSIONS Private insurance with a deductible substantially and problematically reduces medical service use for lower-income insured respondents with diabetes who have an HD; these patients are more likely to report forgoing needed medical services.

Sociodemographic, Clinical, and Treatment-Related Factors Associated With Hyperglycemic Crises Among Adults With Type 1 or Type 2 Diabetes in the US From 2014 to 2020

“…Although rates of hyperglycemic emergencies may be higher among uninsured patients owing to poor access to medical care, healthy food, and housing, 16 , 34 many people with employer-sponsored private health plans have high deductibles and out-of-pocket cost-sharing expenses, 35 which may be associated with financial distress 36 and greater likelihood of forgoing necessary medical care. 37 Young patients may be particularly susceptible to financial instability and underinsurance, 34 , 38 which may be associated with poor glycemic control, 21 , 34 , 39 , 40 inadequate ambulatory care, and ultimately, higher rates of hyperglycemic crises, like those observed in our study. Thus, multidisciplinary teams should anticipate these barriers to care, develop care plans that are affordable and accessible, and help patients navigate available support programs.…”

Changes in Health Insurance Coverage Under the Affordable Care Act: A National Sample of U.S. Adults With Diabetes, 2009 and 2016

“…Health insurance coverage needs to be affordable to improve access to health care and, consequently, reduce diabetesrelated complications. A recent national study showed that lower-income adults with diabetes who had high-deductible insurance plans had significantly lower service use for primary care and specialty visits than lower-income adults with no deductible or a low deductible (16). In the current study, the percentage of income spent on family medical costs significantly decreased over the study period among those with the lowest income, regardless of age; family medical costs were out-ofpocket expenses for medical and dental care and excluded premiums, over-thecounter drugs, and reimbursed costs.…”

Cost-Related Medication Nonadherence in Adults With Diabetes in the United States: The National Health Interview Survey 2013–2018

“…This raises the possibility of underinsurance in the elderly population. To further support this, a study by Yala et al (24) showed that patients with diabetes receiving a low-income subsidy for Medicare Part D were found to have lower out-ofpocket (OOP) costs and better medication adherence, and those with private insurance with a deductible in the nonelderly population with diabetes are more likely to report forgoing needed medical services (25).…”