Evaluation of High-Deductible Health Plans and Acute Glycemic Complications Among Adults With Diabetes
Authors' conclusion
In this cohort study, employer-forced switching to an HDHP was associated with increased odds of potentially preventable acute diabetes complications, potentially because of delayed or deferred care. These findings suggest that employers should be more judicious in their health plan offerings, and health plans and policy makers should consider allowing preventive and high-value services to be exempt from deductible requirements.
Study context
- Population
- Privately insured adults with DM, single insurance carrier with multiple plans across the US, 2010–2018
- Participants
- 42,326 vs 202,729
- Exposure
- Employer-forced switch to HDHP vs no switch
- HDHPn = 42,326
- Did not switchn = 202,729reference
- Outcome
- Odds of severe hypoglycemia and hyperglycemia (ED visits and hospitalizations, by diagnosis codes)
Methodological detailsadministrative claims data, inverse propensity score weighting, mixed-effects logistic regression
- Administrative claims data
- Inverse propensity score weighting
- Mixed-effects logistic regression
Main finding
As reported in the abstract
≥1 hypoglycemia-related ED visit or hospitalization · all study years
Odds ratio (95% CI)P value
HDHPvs Did not switchswitching to HDHP
1.01(0.95–1.06)
P = 0.85HDHPper year of HDHP enrollment
1.02(1.00–1.04)
P = 0.04Observational data: associations, not effects.
Further findings
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| ≥1 hyperglycemia-related ED visit or hospitalization · all study yearsHDHPvs Did not switchSwitching to HDHP · adjusted; inverse propensity score weighting | 1.25 (1.11–1.42) | P < 0.001 | |
| ≥1 hyperglycemia-related ED visit or hospitalization · all study yearsHDHP · per year of HDHP enrollment · adjusted; inverse propensity score weighting | 1.05 (1.01–1.09) | P = 0.02 | |
| 0.512Odds ratio (log scale) |
Original publication
Evaluation of High-Deductible Health Plans and Acute Glycemic Complications Among Adults With Diabetes. JAMA Netw Open. Published 3 January 2023. doi:10.
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