DALLAS, June 28, 2021 – People who are required to pay a deductible of $ 1,000 or more per year as part of their health insurance are less likely to search the emergency room for chest pain and are less likely to be hospitalized during these visits compared to people who have health insurance with an annual deductible of $ 500 or less, according to a new study published today in the American Heart Association’s flagship magazine Circulation.
Chest pain can occur when the heart muscle does not get enough oxygenated blood. It may feel like pressure or squeezing in the chest. The discomfort can also appear in the shoulders, arms, neck, jaw or back and also feel like indigestion. Chest pain can be a symptom of an underlying heart problem, usually coronary artery disease (CHD). There are many types of chest pain, and all chest pain should be evaluated by a doctor.
Health insurers and employers who manage their own health insurance plans are increasingly shifting the burden of health care costs onto patients, the researchers found. By 2020, more than half of U.S. workers were enrolled on high-deductible health insurance, according to the National Employer Health Performance Survey. Previous research has shown that insurance status and financial concerns influence patients’ decision to postpone or skip treatment for many conditions.
“Shifting high health care costs from insurers and employers to patients has become a trend in the United States,” said lead study author Shih-Chuan Chou, MD, MPH, SM, an ambulance doctor with the emergency medicine department in Brigham. and Women’s Hospital in Boston. “Our study is one of the first to examine the impact of a high-deductible health plan on people’s decision to go to an emergency room for chest pain.”
Using a US nationwide health insurance claim database, the researchers identified patients aged 19 to 63 who were enrolled between 2003 and 2014 and whose employers only offered low-deductible health insurance ($ 500 or less / year) for the first year and then enrolled into a high-deductible health insurance plan ($ 1,000 or more / year) in the second year. The control group included members who had been on a low-deductible health insurance plan for two consecutive years.
The study included more than half a million employees in the high-deductible group and nearly six million employees in the control group. The mean age in both groups was 42 years; about half of the participants were women and about two-thirds were non-Hispanic white adults.
The researchers matched people in both groups based on patient-specific demographic and clinical characteristics and employer characteristics (such as total number of employees) to ensure similarities. They looked at whether moving to a high-deductible health insurance plan in the first year (the low-deductible year) compared to the second year (the high-deductible year) had changed employee use of the emergency room for chest pain. They also compared changes in annual patient outcomes from year one to year two between the high deductible group and the corresponding control group (those with low deductible for two consecutive years).
Researchers found:
- Switching to a high-deductible health plan was associated with a 4% reduction in the emergency room for chest pain.
- Enrollment on a high-deductible health insurance plan was associated with an 11% decrease in emergency room visits for chest pain that led to hospitalization.
- Among low-income patients, those on high-deductible health plans were almost a third more likely to have a heart attack during a subsequent hospitalization 30 days after their first visit to the emergency room for chest pain.
“People with higher deductibles delay treatment and are sicker when they show up to the emergency room with chest pain,” Chou said. “When people on low incomes are switched to high-deductible plans, they are disproportionately affected financially, and so is their health.”
Up to 7 million people are treated for chest pain in an emergency room each year. “These results underscore the ramifications associated with health insurance affordability and healthcare costs, particularly for those with chest pain, one of the most common reasons for emergency room visits,” noted Chou.
“Cost is a real factor in patient outcomes,” said Chou. “Clinics must consider actively including costs in our discussions with patients and in joint decisions. Insurers and employers must consider how they will manage plans with high deductibles in the future – especially given the health effects on their employees. “
One limitation of the study is the inherent bias created by using an administrative dataset. However, the study design (broken time series frame and matching) helped to minimize these limitations.
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Co-authors are Arthur S. Hong, MD, MPH; Scott G. Weiner, MD, MPH; and J. Frank Wharam, MBBCh., MPH No sources of funding are listed by the authors.
Additional resources:
Available multimedia content can be found in the right column of the publication link – https://newsroom.heart.org/news/people-with-high-deductible-health-plans-less-likely-to-seek-er-treatment-for -chest- pain? preview = 8c28ca13cf5d55d16d1ff7197c01db1a
You will be able to view the manuscript and editorial online after June 28th.
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Via the American Heart Association
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source https://dailyhealthynews.ca/people-with-high-deductible-health-plans-less-likely-to-seek-er-treatment-for-chest-pain/
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