High-Deductible Health Plans and Healthcare Access, Use, and Financial Strain in Those with Chronic Obstructive Pulmonary Disease

Abstract

Abstract Rationale Medical treatment can improve quality of life and avert exacerbations for those with chronic obstructive pulmonary disease (COPD). High-deductible health plans (HDHPs) can increase exposure to medical costs, and might compromise healthcare access and financial well-being for patients with COPD. Objectives To examine the association of HDHPs with healthcare access, utilization, and financial strain among individuals with COPD. Methods We analyzed privately insured adults aged 40–64 years with COPD in the 2011–2017 National Health Interview Survey, which uses Internal Revenue Service–specified thresholds to classify health plans as “high” or “traditional” deductible coverage. We assessed the association between enrollment in an HDHP and indicators of cost-related impediments to care, financial strain, and healthcare utilization, adjusting for potential confounders. Results Our sample included 803 individuals with an HDHP and 1,334 with a traditional plan. The two groups’ demographic and health characteristics were similar. Individuals enrolled in an HDHP more frequently reported delayed or foregone care, cost-related medication nonadherence, medical bill problems, and financial strain. They also more frequently reported out-of-pocket healthcare spending in excess of $5,000 a year. Although the two groups’ office visit rates were similar, those enrolled in an HDHP were more likely to report a hospitalization or emergency room visit in the past year. Conclusions For patients with COPD, enrollment in an HDHP was associated with cost-related barriers to care, financial strain, and more frequent emergency room visits and hospitalizations.