Impact of emerging health insurance arrangements on diabetes outcomes and disparities: rationale and study design.
Consumer-directed health plans combine lower premiums with high annual deductibles, Internet-based quality-of-care information, and health savings mechanisms. These plans may encourage members to seek better value for health expenditures but may also decrease essential care. The expansion of high-deductible health plans (HDHPs) represents a natural experiment of tremendous proportion. We designed a pre-post, longitudinal, quasi-experimental study to determine the effect of HDHPs on diabetes quality of care, outcomes, and disparities. We will use a 13-year rolling sample (2001-2013) of members of an HDHP and members of a control group. To reduce selection bias, we will limit participants to those whose employers mandate a single health insurance type. The study will measure rates of monthly hemoglobin A1c, lipid, and albuminuria testing; availability of blood glucose test strips; and rates of retinal examinations, high-severity emergency department visits, and preventable hospitalizations. Results could be used to design health plan features that promote high-quality care and better outcomes among people who have diabetes.
Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Ave, 6th floor, Boston, MA 02115, USA. jwharam@post.harvard.edu
J Frank
JF
Wharam
Steve
S
Soumerai
Connie
C
Trinacty
Emma
E
Eggleston
Fang
F
Zhang
Robert
R
LeCates
Claire
C
Canning
Dennis
D
Ross-Degnan
D000293:Adolescent; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000191:economics; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000628:therapy*; D055317:Evidence-Based Practice; D005260:Female; D006264:Health Benefit Plans, Employee / Q000458:organization & administration* / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics; D054624:Health Status Disparities; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000592:standards*; D012107:Research Design; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States
D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents