Impact of emerging health insurance arrangements on diabetes outcomes and disparities: rationale and study design.

Journal Article (Journal Article)

Consumer-directed health plans combine lower premiums with high annual deductibles, Internet-based quality-of-care information, and health savings mechanisms. These plans may encourage members to seek better value for health expenditures but may also decrease essential care. The expansion of high-deductible health plans (HDHPs) represents a natural experiment of tremendous proportion. We designed a pre-post, longitudinal, quasi-experimental study to determine the effect of HDHPs on diabetes quality of care, outcomes, and disparities. We will use a 13-year rolling sample (2001-2013) of members of an HDHP and members of a control group. To reduce selection bias, we will limit participants to those whose employers mandate a single health insurance type. The study will measure rates of monthly hemoglobin A1c, lipid, and albuminuria testing; availability of blood glucose test strips; and rates of retinal examinations, high-severity emergency department visits, and preventable hospitalizations. Results could be used to design health plan features that promote high-quality care and better outcomes among people who have diabetes.

Full Text

Duke Authors

Cited Authors

  • Wharam, JF; Soumerai, S; Trinacty, C; Eggleston, E; Zhang, F; LeCates, R; Canning, C; Ross-Degnan, D

Published Date

  • 2013

Published In

Volume / Issue

  • 10 /

Start / End Page

  • E11 -

PubMed ID

  • 23369764

Pubmed Central ID

  • PMC3562172

Electronic International Standard Serial Number (EISSN)

  • 1545-1151

Digital Object Identifier (DOI)

  • 10.5888/pcd10.120147


  • eng

Conference Location

  • United States