To that point, the researchers noted they didnât examine the health outcomes in each group, only the differences in how long it took patients to seek care. In addition, the findings may not be generalizable to newly insured or newly diagnosed patients or those with extremely high deductibles.
Another limitation, they said, is âour measures did not distinguish appropriate care from unnecessary care, and a proportion of the changes we detected could represent forgoing unnecessary or low-value services.â
Even so, Wharam et al. believe their study should serve as an important warning to policymakers, patients, employers and clinicians.
âWe recommend that clinicians and care management teams monitor the type of insurance that patients with diabetes have and consider further outreach and education for those with high-deductible plans,â they wrote. âUntil the effects of high-deductible plans on long-term macrovascular complications of diabetes are better understood, policymakers and employers should remain cautious in encouraging uptake of such plans among vulnerable patients with diabetes, especially given recent evidence of adverse short-term health outcomes.â
In a related editorial, Mark V. Pauly, PhD, with the University of Pennsylvania, suggested the delays in seeking care couldâve reflected delays in actually needing care among high-deductible participants.
âBecause some people with chronic illness facing such an insurance change would choose to switch jobs, those who remain might have less severe diabetes,â he wrote. âPersons with diabetes in a high-deductible plan might be motivated to adopt healthy behaviors if they know they have to pay for acute events. âŠ So perhaps the longer time to treatment observed by Wharam and colleagues is evidence of better health rather than (or in addition to) a problem with access or a high threshold for care seeking.â
But even considering that potential explanation, Pauly agreed the issues raised by Wharam et al. are worth watching.
âHigh cost sharing is a powerful tool; the authors prudently recommend caution to employers and policymakers considering high-deductible plans,â he wrote. âOne thing is certain: The switch is going to be a bumpy ride.â