Impact of High-Deductible Health Plans on Emergency Department Patients With Nonspecific Chest Pain and Their Subsequent Care
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From Discussion: The contrasting findings between members from neighborhoods of different poverty levels merit particular attention. After HDHP switches, members from lower-poverty neighborhoods reduced invasive procedures after nonspecific chest pain ED visits without changes in ED visits for nonspecific chest pain, hospitalizations, non-invasive testing, or AMI admissions. However, members living in higher-poverty neighborhoods reduced non-specific chest pain ED visits, disproportionately reduced hospitalizations from index ED visits, and significantly increased AMI hospitalization in 30 days after index ED visits. Our findings support that, although HDHPs can reduce potentially low-value acute care among those with higher socioeconomic status, the disproportionate financial pressure from high out-of-pocket costs on lower-income populations appears to lead to unintended consequences with potentially negative health implications.
There is growing evidence that exposing low socioeconomic status populations to high cost-sharing leads to the deferral of appropriate care.
What Is New? High deductible health plan enrollment was associated with increased 30-day acute myocardial infarction rate after emergency department visits for nonspecific chest pain among patients living in neighborhoods with higher poverty rates.
Comment by Don McCanne of PNHP: Keep in mind that high deductibles are a tool used by private insurers to discourage patients from obtaining health care that the insurer might have to pay for. It is a profit-motivated business tool and not a tool to provide assistance to a patient in obtaining beneficial health care. It especially negatively impacts those with greater financial needs. Of note, this study evaluated private commercial and Medicare Advantage plans and not patients in the public Medicare program which avoids high deductibles (though even modest deductibles may be a hardship for those of limited financial means).
In this study of emergency department patients presenting with chest pain, it was found that those with low socioeconomic status who had high deductibles “reduced non-specific chest pain ED visits” and “significantly increased acute myocardial infarction hospitalization in 30 days after index ED visits.” They conclude, “the disproportionate financial pressure from high out-of-pocket costs on lower-income populations appears to lead to unintended consequences with potentially negative health implications.”
We can conclude that “potentially negative health implications” from deferred diagnosis of acute myocardial infarctions includes the potential for death. Since the delays were due to high deductibles, we can further conclude that high deductibles used by private health plans kill people.
We don’t need high deductibles, and we certainly don’t need expensive private insurers who use them to create more wealth for themselves at a cost of providing optimal patient service. After many decades, their profit-maximizing behavior only grows worse. Time to replace them with a single payer improved Medicare for All – no profits, just patient service.
Jesus: Hey, Dad? God: Yes, Son? Jesus: Western civilization followed me home. Can I keep it? God: Certainly not! And put it down this minute--you don't know where it's been! Tom Robbins in Another Roadside Attraction
July 3, 2021 at 2:53 PM #433141Bernie BoomerParticipant
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isn’t even the repetitive nature of the information, proving time and again that lack of care, poor access to care, and marginally beneficial care disproportionately affects the poor while lowering the standard of care for everyone.
It’s that these studies – these proofs are never addressed. The federal government has closed their ears – they don’t want to hear about it for fear it might shift the ‘US healthcare – the best money can buy’ paradigm and put a dent in their industry-stuffed wallets. The MSM is nothing but an echo chamber of corporate approved topics, periodically injected with a rare, critical examination of the real state of the nation – but those provided only as ‘proof’ that they are fair, balanced, unbiased. The mass of the populace . . . well . . . what do you call the kind of blindness that seems to afflict so many?
July 3, 2021 at 3:41 PM #433144soryangParticipant
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It’s a deliberate policy choice with consequences that are completely foreseeable. If one were to say to a judge, “when I pointed the gun at the victim, and pulled the trigger, I didn’t expect anyone to get hurt” at a trial, you would get a worse sentence. It’s laughable, that this result is something that has to proven and that the word “unintentional” is even used.
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