title: Low-socioeconomic-status enrollees in high-deductible plans reduced high-severity emergency care.
abstract: One-third of US workers now have high-deductible health plans, and those numbers are expected to grow in 2014 as implementation of the Affordable Care Act continues. There is concern that high-deductible health plans might cause enrollees of low socioeconomic status to forgo emergency care as a result of burdensome out-of-pocket costs. We analyzed emergency department (ED) visits and hospitalizations over two years among enrollees insured in high-deductible plans through small employers in Massachusetts. We found that plan members of low socioeconomic status experienced 25-30 percent reductions in high-severity ED visits over both years, while hospitalizations declined by 23 percent in year 1 but rose again in year 2. Similar trends were not found among high-deductible plan members of high socioeconomic status. Our findings suggest that plan members of low socioeconomic status at small firms responded inappropriately to high-deductible plans and that initial reductions in high-severity ED visits might have increased the need for subsequent hospitalizations. Policy makers and employers should consider proactive strategies to educate high-deductible plan members about their benefit structures or identify members at higher risk of avoiding needed care. They should also consider implementing means-based deductibles.
authors.affiliation: Department of Population Medicine, Harvard Medical School, Boston, MA, USA. jwharam@post.harvard.edu
authors.forename: J Frank
authors.initials: JF
authors.lastname: Wharam
authors.forename: Fang
authors.initials: F
authors.lastname: Zhang
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Landon
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Soumerai
authors.forename: Dennis
authors.initials: D
authors.lastname: Ross-Degnan
mesh_terms: D000293:Adolescent; D000328:Adult; D017047:Cost Sharing / Q000191:economics* / Q000706:statistics & numerical data*; D003669:Deductibles and Coinsurance / Q000191:economics*; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D006264:Health Benefit Plans, Employee / Q000191:economics* / Q000706:statistics & numerical data; D006279:Health Maintenance Organizations / Q000191:economics / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D010343:Patient Admission / Q000191:economics; D011203:Poverty / Q000191:economics / Q000706:statistics & numerical data; D012923:Social Class; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D014600:Utilization Review; D055815:Young Adult
keywords: Access To Care; Disparities; Employer-Based Insurance System; Managed Care—Consumers