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Men with high deductibles often forgo needed emergency care

Wednesday July 17, 2013
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After switching to high-deductible health plans, men in the United States make fewer ED visits for even severe problems, according to a study.

This self-neglect may lead to a later increase in hospitalization rates, researchers reported in the August issue of the journal Medical Care.

In contrast, women respond to high-deductible health problems by reducing emergency visits only for less severe problems.

The gender differences raise concerns that "men who transition to HDHPs may forgo needed care in the immediate term, resulting in delays or increased severity of illness when care is later sought and received," wrote Katy B. Kozhimannil, PhD, MPA, of the University of Minnesota School of Public Health in Minneapolis, and colleagues.

The researchers analyzed data from members of a large insurance plan whose employers had mandated a switch to a high-deductible health plan. These increasingly popular plans feature lower premiums but higher annual deductibles, which members must typically pay out of pocket. Members in the HDHPs had individual deductibles ranging from $500 to $2,000, with family deductibles of $1,000 to $4,000.

For the study, changes in healthcare use in the first two years were assessed for approximately 6,000 men and 6,500 women in the US who switched to an HDHP. Trends were compared with men and women who remained in a traditional HMO plan.

In the year after transition to an HDHP, men made significantly fewer ED visits. Visits for problems designated as low- and intermediate-severity decreased by 21%, while high-severity visits decreased by 34%, compared with men who remained in HMOs.

Women also made fewer emergency visits after switching to an HDHP, including a 27% reduction in low-severity visits. However, for women there was no decrease in visits for more severe problems.

Men also had a 24% reduction in hospitalizations during their first year in an HDHP. However, this trend was reversed the following year, when hospital admissions increased by 30%. The trends suggest that men might have put off needed care after their deductible went up, leading to more severe illness requiring hospital care later, the authors noted.

The new study is described as one of the first to look at possible gender differences in responses to HDHPs, an increasingly popular way to "incentivize members to reduce inappropriate healthcare while maintaining appropriate use of preventive and necessary services," the authors wrote.

"In our study, the HDHP seemed to act as a 'blunt instrument’ among men, reducing care across the board — emergency visits across all severity level and hospital care — in the year following transition to an HDHP," Kozhimannil said, according to a news release. "In contrast, women seemed to respond to the HDHP largely as intended, maintaining stable rates of intermediate and high severity care and limiting reductions in ED utilization to low-severity visits."

The study raises concerns about some possible unintended consequences of HDHPs, especially among men, who may delay or reduce necessary care when out-of-pocket costs go up, the authors noted. They said health plans and employers may want to develop educational programs to inform HDHP members about their benefits and about the risks of avoiding needed care because of costs.

"Employers that primarily hire men might want to carefully consider whether HDHPs are the optimal choice of coverage," they added.

Read the study abstract: http://bit.ly/18lxb85.


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