Variations in Health Care Utilization Patterns Among Inflammatory Bowel Disease Patients at Risk for High Medical Service Utilization Enrolled in High Deductible Health Plans

Jeffrey A Berinstein; Shirley A Cohen-Mekelburg; Calen A Steiner; Megan McLeod; Mohamed Noureldin; John I Allen; Jeffrey T Kullgren; Akbar K Waljee; Peter D R Higgins

doi:10.1093/ibd/izaa179

Variations in Health Care Utilization Patterns Among Inflammatory Bowel Disease Patients at Risk for High Medical Service Utilization Enrolled in High Deductible Health Plans

Inflamm Bowel Dis. 2021 May 17;27(6):771-778. doi: 10.1093/ibd/izaa179.

Authors

Jeffrey A Berinstein^{1

2}, Shirley A Cohen-Mekelburg^{1

2

3}, Calen A Steiner¹, Megan McLeod¹, Mohamed Noureldin^{1

2}, John I Allen^{1

2}, Jeffrey T Kullgren^{2

3

4}, Akbar K Waljee^{1

2

3}, Peter D R Higgins¹

Affiliations

¹ Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan Medical School, Ann Arbor, MI, USA.
² Institute for Health Care Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI, USA.
³ VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, USA.
⁴ Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, US.

Abstract

Background: High-deductible health plans (HDHPs) are increasing in prevalence as a cost control device for slowing health care cost growth by reducing nonessential medical service utilization. High cost-sharing associated with HDHPs can lead to significant financial distress and worse disease outcomes. We hypothesize that chronic disease patients are delaying or foregoing necessary medical care due to health care costs.

Methods: A retrospective cohort analysis of IBD patients at risk for high medical service utilization with continuous enrollment in either an HDHP or THP from 2009 to 2016 were identified using the MarketScan database. Health care costs were compared between insurance plan groups by Kruskal-Wallis test. Temporal trends in office visits, colonoscopies, emergency department (ED) visits, and hospitalizations were evaluated using additive decomposition time series analysis.

Results: Of 605,862 patients with a diagnosis of IBD, we identified 13,052 eligible patients. Annual out-of-pocket costs were higher in the HDHP group (n = 524) than the THP group (n = 12,458) ($2870 vs $1,864; P < 0.001) without any difference in total health care expenses ($23,029 vs $23,794; P = 0.583). Enrollment in an HDHP influenced colonoscopy, ED visit, and hospitalization utilization timing. Colonoscopies peaked in the fourth quarter, ED visits peaked in the first quarter, and hospitalizations peaked in the third and fourth quarter.

Conclusions: High-deductible health plan enrollment does not change the cost of care; however, it shifts health care costs onto patients and changes the timing of the care they receive. High-deductible health plans are incentivizing delays in obtaining health care with a potential to cause worse disease outcomes and financial distress. Further evaluation is warranted.

Keywords: IBD; cost-sharing; health insurance; health plans; health services; high deductible; out-of-pocket costs; outcomes.

MeSH terms

Chronic Disease
Deductibles and Coinsurance*
Humans
Inflammatory Bowel Diseases* / therapy
Insurance, Health / classification*
Patient Acceptance of Health Care*
Retrospective Studies

Abstract

MeSH terms

Grants and funding