Association Between Switching to a High-Deductible Health Plan and Major Cardiovascular Outcomes.
Importance: Most people with commercial health insurance in the US have high-deductible plans, but the association of such plans with major health outcomes is unknown. Objective: To describe the association between enrollment in high-deductible health plans and the risk of major adverse cardiovascular outcomes. Design, Setting, and Participants: This cohort study examined matched groups before and after an insurance design change. Data were from a large national commercial (and Medicare Advantage) health insurance claims data set that included members enrolled between January 1, 2003, and December 31, 2014. The study group included 156 962 individuals with risk factors for cardiovascular disease who were continuously enrolled in low-deductible (≤$500) health plans during a baseline year followed by up to 4 years in high-deductible (≥$1000) plans with typical value-based features after an employer-mandated switch. The matched control group included 1 467 758 individuals with the same risk factors who were contemporaneously enrolled in low-deductible plans. Data were analyzed from December 2017 to March 2020. Exposures: Employer-mandated transition to a high-deductible health plan. Main Outcomes and Measures: Time to first major adverse cardiovascular event defined as myocardial infarction or stroke. Results: The study group included 156 962 individuals and the control group included 1 467 758 individuals; the mean age of members was 53 years (SD: high-deductible group, 6.7 years; control group, 6.9 years), 47% were female, and approximately 48% lived in low-income neighborhoods. First major adverse cardiovascular events among high-deductible health plan members did not differ relative to controls at follow-up vs baseline (adjusted hazard ratio, 1.00; 95% CI, 0.89-1.13). Findings were similar among subgroups with diabetes (adjusted hazard ratio, 0.93; 95% CI, 0.75-1.16) and with other cardiovascular risk factors (adjusted hazard ratio, 0.93; 95% CI, 0.81-1.07). Conclusions and Relevance: Mandated enrollment in high-deductible health plans with typical value-based features was not associated with increased risk of major adverse cardiovascular events.
Wharam, JF; Wallace, J; Zhang, F; Xu, X; Lu, CY; Hernandez, A; Ross-Degnan, D; Newhouse, JP
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