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Diabetics with high self-esteem plans are more likely to delay care

(Reuters Health) – Diabetes workers who switch to high-end health plans who need to pay more out of pocket for…

(Reuters Health) – Diabetes workers who switch to high-end health plans who need to pay more out of pocket for care may be more likely than those who stay in low plans to delay the necessary controls, a US study suggests.

People with diabetes are at risk of life-threatening blood vessel disease. Left untreated, these conditions can lead to complications such as myocardial infarction, stroke and amputation.

For the survey, researchers examined data of nearly 34,000 people with diabetes who had initially employers-based health plans with a deduction of $ 500 or less – but then their employers left to only offer plans of $ 1000 or more. The study group also looked at a comparison group with nearly 295,000 diabetes workers who consistently had a deduction of $ 500 or less.

Before the first group switched to higher self-esteem plans, there was no meaningful difference between the groups for how long patients waited for dealing with complications that could be life-threatening without time-limited treatment, found the study.

However, over the four years after a few employers left to offer only high-deductible plans, patients on these plans averaged 1

.5 months longer than those with low self-esteem plans to seek new symptoms of cardiovascular complications associated with diabetes, 9 months longer for diagnostic tests and 3.1 months longer for medical treatment to treat these complications.

“We found that delays or decreases in cardiovascular care continued during a relatively long follow-up and also occurred for services used for life-threatening conditions,” said Dr. Frank Wharam of Harvard Medical School and Harvard Pilgrim Health Care Institute in Boston.

An increasing proportion of Americans, including people with diabetes, have high deductible health insurance plans that require that they pay up to about $ 1,000 to $ 7,000 out of pocket per year if they use healthcare services, researchers note in Annals of Internal Medicine. However, studies to date have not provided a clear picture of how this additional cost can affect healthcare utilization for people with diabetes.

The study can not prove whether or not the costs may have affected how long patients waited for any necessary exams, laboratory tests or treatments.

However, it is likely that the money played a role because all of the study had diabetes with similar risks for cardiovascular complications, Wharam said by email.

“We can speculate on the diabetes patients’ knowledge of the high costs of care and a desire to save money led to these patterns,” said Wharam.

All patients in the study had employer-sponsored health insurance provided by one single US health insurance company between 2003 and 2012, and their employers offered no more than one insurance option in a particular year.

People who switched to high self-esteem plans were 6 percent less likely to apply for the first new major symptom of complications during the study, such as chest or leg pain. They were also 9 percent less likely to get the first diagnostic test they needed and 9 percent less likely to get procedures to treat these complications.

Compared to those who were in indebted plans throughout the study, those who switched to higher deductibles increased their health expenses by 43 percent to 53 percent per annum.

The research team could not verify why patients may have chosen to wait for the necessary care, which makes it impossible to prove that increased costs were partially or completely responsible, notes the authors.

“I’m not aware of any rigorous studies that ask about motives and thought processes, but the economic model would suggest that a person who would have to pay more would delay care of mild symptoms that could solve oneself.” Mark Pauly from Wharton School and Perelman School of Medicine at the University of Pennsylvania in Philadelphia.

“Someone whose care is free because insurance covers it would be more likely to seek care at the first sign of a symptom,” said Pauly, author of an accompanying editorial, by email.

SOURCE: 2qUsCyw and Annals of Internal Medicine, online 19 November 2018.

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