Study: Patients with High Deductible Plans More Likely to Delay Care

Patients with acute diverticulitis or appendicitis who had high cost-sharing health plans were less likely than patients with low cost-sharing plans to present with early, uncomplicated disease, according to a recent study published in JAMA Health Forum. In this study of 151,852 patients, treatment delays were associated with increased morbidity and higher costs.

Investigators also found that high-cost sharing was associated with a lower likelihood of receiving minimally invasive surgery if a procedure was performed. Study authors said the results were consistent even after controlling for patient comorbidities, community-level socioeconomic deprivation, and regional variation.

Investigators used Health Care Cost Institute claims from January 1, 2013, through December 31, 2017, to analyze data of commercially insured patients hospitalized for acute appendicitis or diverticulitis.

Investigators assessed the degree of cost sharing, defined as the patient’s coinsurance, copayment, and deductible. Total member cost sharing was defined as quartiles and expressed in U.S. dollars. The low cost-sharing group was defined patients who were in quartile 1, with cost-sharing of between $0 and $502, and the high cost-sharing group was quartile 4, with cost sharing greater than $3,082.

Among all patients (52.4% men and 47.6% women), the total cost-sharing median was $1,725.

In the highest cost-sharing group, investigators saw a steady increase in the percentage of patients per year from 2013 through 2017 (20.9% to 29.0%).

The investigators also found that more patients in the lower cost-sharing group (75.7%) sought early treatment when their disease was uncomplicated than those in the higher cost-sharing group (65%).

“These are timely findings given growing efforts to increase cost sharing in high-deductible coverage for nongroup and individual marketplace plans,” investigators wrote. “Although these policies aim to increase individual responsibility in healthcare behavior, it is becoming increasingly clear that the clinical and financial consequences are severe.”

“These are timely findings given growing efforts to increase cost sharing in high-deductible coverage for nongroup and individual marketplace plans,” investigators wrote. “Although these policies aim to increase individual responsibility in healthcare behavior, it is becoming increasingly clear that the clinical and financial consequences are severe.”

Acute diverticulitis is inflammation due to a perforation of a diverticulum, a sac-like protrusion of the colon wall. Complicated diverticulitis is associated with the formation of abscess, fistula, bowel obstruction, or frank perforation. Diverticulosis is present in about 60% of people older than 60 years. Diverticulitis occurs in about 10% to 25% of patients with diverticulosis.

Acute appendicitis is inflammation of the appendix, a pouch on the colon. It occurs most often in younger people, with a mean age of 28. Men have a slightly higher predisposition of developing acute appendicitis compared with women, with a lifetime incidence of 8.6% and 6.7% for men, and women, respectively. There are about 300,000 hospital visits yearly in the United States for appendicitis-related issues.

Premiums and out-of-pocket spending have increased, according to Kaiser Family Foundation. In 2018, the average family spent $4,706 on premiums and $3,020 on cost-sharing, for a combined cost of $7,726. This represents an 18% increase from 2013.