title: Among Low-Income Respondents With Diabetes, High-Deductible Versus No-Deductible Insurance Sharply Reduces Medical Service Use.
abstract: To contrast the effect of private insurance and deductibles (by size) on medical service use, health status, and medical debt for adult respondents with diabetes with low and high incomes.
  
  
  
  Using the 2011-2013 Medical Expenditure Panel Survey, bivariate and regression analyses were conducted to compare demographic characteristics, medical service use, diabetes care, and health status among privately insured adult respondents with diabetes, aged 18-64 years (N = 1,461) by lower (<200% of the federal poverty level) and higher (≥200% of the federal poverty level) income and deductible vs. no deductible (ND), low deductible ($1,000/$2,400) (LD), and high deductible (>$1,000/$2,400) (HD). The National Health Interview Survey 2012-2014 was used to analyze differences in medical debt and delayed/avoided needed care among adult respondents with diabetes (n = 4,058) by income.
  
  
  
  Compared with privately insured respondents with diabetes with ND, privately insured lower-income respondents with diabetes with an LD report significant decreases in service use for primary care, checkups, and specialty visits (27%, 39%, and 77% lower, respectively), and respondents with an HD decrease use by 42%, 65%, and 86%, respectively. Higher-income respondents with an LD report significant decreases in specialty (28%) and emergency department (37%) visits. Diabetes care measures are similar by income and insurance; there were no changes in physical health status. Medical debt is similar by income, but deferred service use is two times greater for those indebted and with lower income.
  
  
  
  Private insurance with a deductible substantially and problematically reduces medical service use for lower-income insured respondents with diabetes who have an HD; these patients are more likely to report forgoing needed medical services.
authors.affiliation: Department of Family Medicine, Georgetown University School of Medicine, Washington, DC.
authors.forename: David L
authors.initials: DL
authors.lastname: Rabin
authors.affiliation: Robert Graham Center, Washington, DC ajetty@aafp.org.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Jetty
authors.affiliation: Robert Graham Center, Washington, DC.
authors.forename: Stephen
authors.initials: S
authors.lastname: Petterson
authors.affiliation: Department of Family Medicine, Georgetown University School of Medicine, Washington, DC.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Saqr
authors.affiliation: Department of Family Medicine, Georgetown University School of Medicine, Washington, DC.
authors.forename: Allison
authors.initials: A
authors.lastname: Froehlich
mesh_terms: D000293:Adolescent; D000328:Adult; D003669:Deductibles and Coinsurance / Q000191:economics*; D003920:Diabetes Mellitus / Q000191:economics*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005191:Family Characteristics; D005260:Female; D005102:Health Expenditures; D006801:Humans; D007182:Income; D007348:Insurance, Health / Q000191:economics; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors; D055815:Young Adult