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High deductible health plans (HDHPs) were introduced as a mechanism to reduce healthcare spending by incentivizing patients to be more cost-conscious while making premiums less costly. However, data on the impact of HDHPs on utilization of services required for optimal management of chronic health conditions such as diabetes and on subsequent health outcomes are scarce.
Systematic literature review of studies published between 01/01/2000 and 05/07/2021 that examined the impact of HDHP on diabetes monitoring (e.g., recommended laboratory and surveillance testing), routine care (e.g., ambulatory appointments), medication management (e.g. medication initiation, adherence), and acute healthcare utilization (e.g., emergency department visits, hospitalizations, incident complications).
Of 303 reviewed articles, eight were relevant. These studies demonstrated that HDHPs lower spending at the expense of reduced high-value diabetes monitoring, routine care, and medication adherence, potentially contributing to observed increases in acute healthcare utilization. Additionally, patient out-of-pocket costs for recommended screenings doubled, and total healthcare expenditures increased 49.4%, for HDHP enrollees compared to enrollees in traditional health plans. Reductions in disease monitoring and routine care and increases in acute healthcare utilization were greatest in lower income patients. None of the studies examined the impact of HDHPs on access to diabetes self-management education, technology use, or glycemic control.
While HDHPs reduce some healthcare utilization and costs, they appear to do so at the expense of limiting high-value care and medication adherence. Policymakers, providers, and payers should be more cognizant of the potential for negative consequences of HDHPs on patients’ health.
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