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papers

Low-socioeconomic-status enrollees in high-deductible plans reduced high-severity emergency care

Published: August 1, 2013
Category: Papers
Authors: Landon BE, Ross-Degnan D, Soumerai SB, Wharam JF, Zhang F
Country: United States
Language: null
Type: Care Management
Setting: Health Plan

Health Aff 32:1398-1406.

Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA

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.

PMID: 23918484

Payment,Targeted Program,Population Markers,Cost Burden Evaluation,United States,Adolescent,Adult,Gender,Health Benefit Plans,Employee/utilization,Health Maintenance Organizations/economics,Health Maintenance Organizations/utilization,Massachusetts,Middle Aged,Patient Admission/economics,Poverty/economics,Poverty/statistics & numerical data,Utilization Review,Young Adult

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