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Effect of high-deductible insurance on health care use in bipolar disorder.

Publication ,  Journal Article
Wharam, JF; Busch, AB; Madden, J; Zhang, F; Callahan, M; LeCates, RF; Foxworth, P; Soumerai, S; Ross-Degnan, D; Lu, CY
Published in: Am J Manag Care
June 2020

OBJECTIVES: To determine the impact of high-deductible health plans (HDHPs) on health care use among individuals with bipolar disorder. STUDY DESIGN: Interrupted time series with propensity score-matched control group design, using a national health insurer's claims data set with medical, pharmacy, and enrollment data. METHODS: The intervention group was composed of 2862 members with bipolar disorder who were enrolled for 1 year in a low-deductible (≤$500) plan and then 1 year in an HDHP (≥$1000) after an employer-mandated switch. HDHP members were propensity score matched 1:3 to contemporaneous controls in low-deductible plans. The main outcomes included out-of-pocket spending per health care service, mental health-related outpatient visits (subclassified as visits to nonpsychiatrist mental health providers and to psychiatrists), emergency department (ED) visits, and hospitalizations. RESULTS: Mean pre- to post-index date out-of-pocket spending per visit on all mental health office visits, nonpsychiatrist mental health provider visits, and psychiatrist visits increased by 21.9% (95% CI, 15.1%-28.6%), 33.8% (95% CI, 2.0%-65.5%), and 17.8% (95% CI, 12.2%-23.4%), respectively, among HDHP vs control members. The HDHP group experienced a -4.6% (95% CI, -11.7% to 2.5%) pre- to post change in mental health outpatient visits relative to controls, a -10.9% (95% CI, -20.6% to -1.3%) reduction in nonpsychiatrist mental health provider visits, and unchanged psychiatrist visits. ED visits and hospitalizations were also unchanged. CONCLUSIONS: After a mandated switch to HDHPs, members with bipolar disorder experienced an 11% decline in visits to nonpsychiatrist mental health providers but unchanged psychiatrist visits, ED visits, and hospitalizations. HDHPs do not appear to have a "blunt instrument" effect on health care use in bipolar disorder; rather, patients might make trade-offs to preserve important care.

Duke Scholars

Published In

Am J Manag Care

DOI

EISSN

1936-2692

Publication Date

June 2020

Volume

26

Issue

6

Start / End Page

248 / 255

Location

United States

Related Subject Headings

  • United States
  • Patient Acceptance of Health Care
  • Middle Aged
  • Medically Uninsured
  • Male
  • Insurance, Health
  • Humans
  • Health Policy & Services
  • Female
  • Deductibles and Coinsurance
 

Citation

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Chicago
ICMJE
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Wharam, J. F., Busch, A. B., Madden, J., Zhang, F., Callahan, M., LeCates, R. F., … Lu, C. Y. (2020). Effect of high-deductible insurance on health care use in bipolar disorder. Am J Manag Care, 26(6), 248–255. https://doi.org/10.37765/ajmc.2020.43487
Wharam, J Frank, Alisa B. Busch, Jeanne Madden, Fang Zhang, Matthew Callahan, Robert F. LeCates, Phyllis Foxworth, Stephen Soumerai, Dennis Ross-Degnan, and Christine Y. Lu. “Effect of high-deductible insurance on health care use in bipolar disorder.Am J Manag Care 26, no. 6 (June 2020): 248–55. https://doi.org/10.37765/ajmc.2020.43487.
Wharam JF, Busch AB, Madden J, Zhang F, Callahan M, LeCates RF, et al. Effect of high-deductible insurance on health care use in bipolar disorder. Am J Manag Care. 2020 Jun;26(6):248–55.
Wharam, J. Frank, et al. “Effect of high-deductible insurance on health care use in bipolar disorder.Am J Manag Care, vol. 26, no. 6, June 2020, pp. 248–55. Pubmed, doi:10.37765/ajmc.2020.43487.
Wharam JF, Busch AB, Madden J, Zhang F, Callahan M, LeCates RF, Foxworth P, Soumerai S, Ross-Degnan D, Lu CY. Effect of high-deductible insurance on health care use in bipolar disorder. Am J Manag Care. 2020 Jun;26(6):248–255.

Published In

Am J Manag Care

DOI

EISSN

1936-2692

Publication Date

June 2020

Volume

26

Issue

6

Start / End Page

248 / 255

Location

United States

Related Subject Headings

  • United States
  • Patient Acceptance of Health Care
  • Middle Aged
  • Medically Uninsured
  • Male
  • Insurance, Health
  • Humans
  • Health Policy & Services
  • Female
  • Deductibles and Coinsurance