Men in the U.S. are forgoing emergency room care -- even in extreme cases -- after switching to high-deductible health plans (HDHPs), according to a study in the journal Medical Care.
The study, published by an offshoot of Wolters Kluwer Health, suggests this trend may lead to a later increase in hospitalization rates. Conversely, women respond to HDHPs by reducing emergency visits only for less-severe problems.
"In our study, the HDHP seemed to act as a 'blunt instrument' among men, reducing care across the board—emergency visits across all severity levels and hospital care— in the year following transition to an HDHP," according to study author Katy B. Kozhimannil, PhD, MPA, of University of Minnesota School of Public Health, Minneapolis, and colleagues. "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."
High-deductible plans are often put in place to "incentivize members to reduce inappropriate health care while maintaining appropriate use of preventive and necessary services," according to the study.
DEDUCTIBLES UP, MEN STAY HOME
Researchers looked at about 6,000 men and 6,500 women in the first two years after switching to an HDHP, comparing trends with men and women who remained in a traditional HMO plan.
In the year after the switch to an HDHP, men's high-severity visits decreased by 34 percent, while visits for low- and intermediate-severity problems went down 21 percent.
The women studied saw a 27 percent decrease in low-severity emergency room visits after switching to an HDHP, but there was no decrease in visits for more severe problems.
The researchers looked at data from a large insurance plan on members whose employers had mandated a switch to an HDHP – these plans are becoming more popular, and while they typically have lower premiums, they have higher annual deductibles that members often must pay out of pocket.
Members in the HDHPs had individual deductibles ranging from US$500 to $2,000, with family deductibles of US$1,000 to $4,000.
HIGH RISK LATER?
In their first year with an HDHP, men saw a 24 percent reduction in hospitalizations, however, the next year, men's hospital admissions increased by 30 percent, suggesting men might have put off needed care after their deductible went up.
Dr Kozhimannil and coauthors suggest that health plans and employers may want to develop educational programs to inform HDHP members about their benefits, and the risks of avoiding needed care because of costs.
"The study points to a general lack of understanding of how modern high-deductible plans affect important patient subgroups," said Dr. Frank Wharam of Harvard Pilgrim Health Care Institute, senior author of the study.