Association Between High-Deductible Health Plans and Engagement in Routine Medical Care for Type 2 Diabetes in a Privately Insured Population: A Propensity Score–Matched Study

Objective: High deductible health plans (HDHP) are increasingly more common but can be challenging for patients to navigate and may negatively impact care engagement for chronic conditions such as type 2 diabetes. We seek to understand how higher out-of-pocket costs affect participation in provider visits, medication adherence, and routine monitoring of patients with type 2 diabetes with HDHPs.

Methods: In a retrospective cohort of 19,379 Kaiser Permanente Northern California patients with type 2 diabetes (age 18-64), 6,801 patients with HDHPs were compared with those with a no deductible plan using propensity score matching. We evaluated the number of telephone and office visits with primary care, oral diabetic medication adherence, and rates of HbA1c testing, blood pressure monitoring, and retinopathy screening.

Results: Patients with a HDHP had fewer primary care office visits compared to patients with no deductible (4.25 vs 4.85 visits per person, p<0.001), less retinopathy screening (49.9% vs 53.3%, p<0.001), less A1c and blood pressure measurement (46.7% vs 51.4%, p<0.001, 93.2% vs 94.4%, p=0.004) compared to the control group. Medication adherence was not significantly different between patients with a HDHP or no deductible (57.4% vs 58.6%, p=0.234).

Conclusions: HDHPs appear to be a barrier for patients with type 2 diabetes and reduces care participation by in both visits that would have out-of-pocket costs and preventive care without out-of-pocket costs, possibly due to the increased complexity of cost sharing under an HDHP, and potentially leading to decreased monitoring of important clinical measurements.