- Health insurance costs have been rising, and more of a financial burden has fallen on the patients.
- Evidence shows that insurance status and financial concerns can cause people to delay or skip care.
- As of 2020, approximately 57 percent of workers in the United States were enrolled in a high-deductible healthcare plan.
New research published this month in the journal
Health insurance costs have been rising, and in recent years more of a financial burden has fallen on the patient.
Evidence shows that insurance status and financial concerns can cause people to delay or skip care.
Patients with lower socioeconomic status are disproportionately impacted — both financially and medically.
This study is the first to look at how those concerns specifically impact patients’ willingness to go to the emergency room for chest pain — a symptom that may be a sign of an underlying heart problem like coronary heart disease.
“While it is not surprising, it is still very sobering. We need to have rational insurance design. And when the design of the policy leads to worse outcomes, that is a major problem,” said Dr. Howard Forman, a professor of radiology and public health at Yale University.
Researchers evaluated health claims from a nationwide U.S. health insurer of more than half a million people between 19 and 63 years old.
Of the patients, over half a million were offered a low-deductible health plan (defined as $500 or less a year) in the first year and then were required to switch to a high-deductible plan (defined as $1,000 or more a year) in the second year.
The second group of participants, which served as the control group and included about 6 million people, stayed enrolled in a low-deductible plan for two years.
Researchers found that switching to the high-deductible health plan was linked to a 4 percent drop in emergency room visits for chest pain.
Also, those with high-deductible plans were associated with an 11 percent decrease in ER visits for chest pain that led to hospitalization.
In addition, low-income patients with high-deductible plans were about one-third more likely to experience a heart attack within 30 days after first visiting the ER for chest pain.
“Cost is a real factor for patient outcomes. Clinicians need to consider actively including cost in our discussions with patients and in shared decision-making. Insurers and employers need to consider how they will manage high-deductible plans going forward – particularly given the health impact on their employees,” lead study author Dr. Shih-Chuan Chou, an emergency care physician in the department of emergency medicine at Brigham and Women’s Hospital in Boston, said in
Research has shown that the type of insurance and financial concerns influence when and if people seek care for medical issues.
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The switch appears to have affected visits for only low-severity health issues. Also, the impact has been most pronounced among individuals with low socioeconomic status.
A 2013 study found that patients with low socioeconomic status recorded a 25 to 30 percent decline in ER visits for high-severity health issues after switching to a high-deductible plan.
“People with higher deductibles delay treatment and are sicker when they show up in the ER for chest pain. When people with low incomes are switched to high-deductible plans, they are disproportionately impacted financially, and so is their health,” Chou said in the statement.
Delaying treatment — especially for issues like chest pain — can have life-threatening consequences.
“There is a saying that ‘time is muscle.’ This means that the longer it takes to treat an acute myocardial infarction, the more permanent damage then ensues. We should encourage timely diagnosis and treatment in this setting,” Forman said.
Forman says this effect has been known for years, and healthcare experts have hoped that education and awareness could encourage people to seek care faster.
“We had hoped (and still hope) that better consumer information and education can help make better decisions. But this may not be possible in the setting of acute chest pain,” Forman said.
In recent years, patients have taken on more out-of-pocket costs as the price of health insurance plans surged, often placing more financial burdens on patients.
As of 2020, approximately 57 percent of workers in the United States were enrolled in a high-deductible healthcare plan.
According to Forman, insurance policies need to be designed to improve patient outcomes — not worsen them.
“There are emerging value-based designs to insurance that seek to strike a more rational balance. We need to prioritize the health of the patient before saving money. We can do both, but not with blunt instruments,” Forman said.
New research found that people with high-deductible health insurance plans are less likely to seek medical care for chest pain than those with low-deductible health insurance plans. Previous evidence has found the type of insurance and financial concerns may cause patients to delay or skip care, but this is the first to specifically look at chest pain. Out-of-pocket costs have been increasing for patients in recent years, and in some cases, can lead to worse health outcomes.