People with highly deductible health plans are less likely to seek emergency treatment for chest pain

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People who have to spend $ 1,000 or more a year on out-of-pocket medical deductibles under their health insurance plan are less likely to seek emergency care for chest pain and less likely to be hospitalized during these visits. , compared to people who have health insurance plans with an annual deductible of $ 500 or less, according to new research published today in the American Heart Association’s flagship journal Circulation.

Chests it can occur when the heart muscle does not get enough oxygen-rich blood. It may seem like pressure or tightness in the chest. Discomfort can also occur in the shoulders, arms, neck, jaw or back and can also have indigestion. Chest pain can be a symptom of an underlying heart problem, usually coronary heart disease (CHD). There are many types of , and all chest pain should be checked for professional.

Medical insurance and employers who manage their own plans are increasingly shifting the burden of healthcare costs to patients, the researchers noted. By 2020, more than half of U.S. employees were enrolled in a highly deductible health plan, according to the National Employer Health Benefits Survey. Previous research has shown that the state of insurance and financial concerns affect patients ’decisions to delay or omit seeking care for many medical conditions.

“Changing the high cost of health care from insurers and employers to patients has become a trend across the United States,” said study lead author Shih-Chuan Chou, MD, MPH , SM, emergency care physician in Brigham’s emergency medicine department. and Boston Women’s Hospital. “Our study is one of the first to examine the impact of a highly deductible health care plan on people’s decisions to go to an emergency room for chest pain.”

Using the claims database of a U.S. medical insurer, the researchers identified patients aged 19 to 63, enrolled between 2003 and 2014, whose employers only offer low-deductible health plans ($ 500). or less / year) the first year and then forced to enroll in a highly deductible health plan ($ 1,000 or more / year) during the second year. He it included members who were enrolled in a low-deduction health plan for two years in a row.

The study included more than half a million employees in the group with deductible discharges and nearly six million employees in the control group. In both groups, the mean age was 42 years; about half of the participants were women and about two-thirds were non-Hispanic white adults.

The researchers related people from both groups according to the specific clinical and demographic characteristics of the patient and the characteristics of the employer (such as the total number of employees) to ensure similarity. They examined whether switching to a highly deductible health plan changed the use that emergency room employees made for chest pain during the first year (the year with low deduction) compared to the second year (l year with high deduction). They also compared changes in patients ’annual outcomes from year one to year 2 between the highly deductible health plan group and the controlled control group (those with a low deductible plan for two consecutive years).

The researchers found:

  • The change to a highly deductible health plan was associated with a 4% reduction in emergency room visits for chest pain.
  • Enrollment in a highly deductible health plan was associated with an 11% decrease in emergency room visits for chest pain that led to hospitalization.
  • Among low-income patients, those with highly deductible health plans were nearly a third more likely to suffer a heart attack during a subsequent hospitalization 30 days after their initial emergency room visit for chest pain.

“People with higher deductibles delay treatment and are sicker when they go to the emergency room for chest pain,” Chou said. “When people on low incomes switch to deductible plans, they are disproportionately affected financially and their health as well.”

Each year, up to 7 million people are cared for in an emergency department for chest pain. “These results highlight the consequences associated with the affordability of health insurance and health care costs, especially for patients with illness. pain, one of the most common reasons for emergency room visits, “Chou noted.

“Cost is a real factor for patient outcomes,” Chou said. “Clinicians need to consider the possibility of actively including costs in our conversations with patients and in shared decision-making. Insurers and employers need to consider how they will manage high-deduction plans in the future, especially taking into account the impact on the health of its employees “.

One limitation of the study is the inherent bias created by the use of an administrative data set. However, the design of the study (interrupted time frame and coincidence) helped minimize these limitations.


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More information:
Circulation (2021). DOI: 10.1161 / CIRCULATIONAHA.120.052501

Citation: People with highly deductible health plans are less likely to seek emergency treatment for chest pain (2021, June 28), retrieved June 28, 2021 at https://medicalxpress.com/news/2021 -06-people-high-deductible-health- er-treatment.html

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