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Principal Investigator: Risha Gidwani Marszowski
Organization: UNIVERSITY OF COLORADO DENVER
Fiscal Year: 2024
Award: $728,784
Funding agency: National Institute on Aging
Enrollment in high deductible health plans (HDHPs) has increased 50% in the past 5 years, with more than
45% of privately-insured Americans enrolled in such plans. HDHPs require patients to pay 100% of the costs of
most care (excluding some primary or secondary preventive care) out of pocket until a (high) deductible is met.
Services provided for chronic disease management are subject to this deductible. Therefore, it is unclear
whether this form of insurance supports healthy aging, especially for the 70% of Americans aged 50-64 (an
NIA priority population) with chronic illness. High patient cost-sharing has caused decreases in use of both
necessary and unnecessary health care. However, it is not known whether reductions in healthcare use mean
that patients are not receiving the types of healthcare required to manage their chronic diseases.
The overarching goal of this study is to ascertain whether the high cost-sharing design of HDHPs results in
chronically-ill patients not receiving the evidence-based, high-quality care recommended for management their
illnesses and secondarily, whether the cost barriers built into their design result in poorer health outcomes for
HDHP enrollees. We also estimate the magnitude of patient spending required to receive high quality care in
HDHPs versus non-HDHPs and investigate any race-, gender-, or income-based disparities in care
experienced by HDHP patients. We focus our HDHP investigations on patients who have one or more of the
following common chronic illnesses: diabetes, coronary artery disease, heart failure, asthma, hypertension, or
major depression. Lastly, we use a temporary benefit design change enacted during the COVID-19 pandemic
as an exogenous shock to understand the impact of HDHPs on receipt of recommended medical care.
Previously HDHP research has not focused on impacts on populations most in need of services (i.e., those
with chronic conditions) and the impact of HDHPs on disparities. We evaluate, for the substantial proportion of
mid-life adults with high healthcare needs, whether this common benefit design results in lower utilization of
care (due to high patient out-of-pocket costs) and adverse health outcomes.
Results from this work are policy-relevant. Findings can inform regulations regarding the exemption of chronic
disease management from insurance deductibles and identify the best way to support value-based insurance
design. To ensure findings reach decision makers, we will disseminate results through RAND Research Briefs
to insurance purchasers, leaders at insurance companies, state departments of insurance, and members of
Congress, in addition to traditional mechanisms of dissemination to the scientific community.
Terms: <21+ years old><Address><Adult><Adult Human><Adverse Experience><Adverse event><Affect><Age><Ambulatory Care><American><Asthma><Bronchial Asthma><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Caring><Cessation of life><Chronic><Chronic Disease><Chronic Illness><Chronically Ill><Circulatory Collapse><Clinical Practice Guideline><Communities><Congresses><Coronary Arteriosclerosis><Coronary Artery Disease><Coronary Artery Disorder><Coronary Atherosclerosis><Cost Sharing><Data><Death><Deductibles><Diabetes Mellitus><Disease><Disease Management><Disorder><Disorder Management><Disparities><Disparity><Drugs><Economic Income><Economical Income><Eligibility><Eligibility Determination><Enrollment><Ensure><Evaluation><Exclusion><Family><Gatekeeping><Gender><Goals><Guidelines><Health><Health Care Costs><Health Costs><Health Insurance for Aged and Disabled, Title 18><Health Insurance for Disabled Title 18><Healthcare><Healthcare Costs><Heart failure><Hypertension><Income><Individual><Insurance><Insurance Carriers><Insurers><Investigation><Literature><Major Depressive Disorder><Measures><Medical><Medicare><Medication><Modeling><National Institute of Aging><National Institute on Aging><Out-of-Pocket Expense><Out-patients><Outcome><Outpatient Care><Outpatients><Patients><Performance><Pharmaceutical Preparations><Policies><Population><Preventative care><Prevention Research><Preventive care><Privatization><Process><Protocol Screening><QOC><Quality of Care><Quasi-experiment><Quasi-experimental analysis><Quasi-experimental approach><Quasi-experimental design><Quasi-experimental methods><Quasi-experimental research><Quasi-experimental study><Quasi-experimental technique><Race><Races><Recommendation><Regulation><Research><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Services><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Shock><Testing><Title 18><Uncovered Medical Expenses><Uncovered Uninsured Medical Expense><Uninsured Medical Expense><Vascular Hypertensive Disease><Vascular Hypertensive Disorder><Visit><Vulnerable Populations><Work><access to health care><access to healthcare><accessibility of health care><accessibility to health care><accessibility to healthcare><acute care><adulthood><aged><ages><atherosclerotic coronary disease><burden of chronic disease><burden of chronic illness><cardiac failure><care costs><care seeking><chronic disorder><circulatory 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plans><healthcare access><healthcare accessibility><healthcare availability><healthcare disparity><healthcare inequality><healthcare inequity><healthcare quality><healthcare service access><healthcare service availability><healthy aging><healthy human aging><high blood pressure><hyperpiesia><hyperpiesis><hypertensive disease><hypertensive disorder><incomes><inequality due to race><inequity due to race><insurance plan><major depression><major depression disorder><medical expenses not covered by insurance><medically necessary><medically necessary care><member><mid life><mid-life><middle age><middle aged><midlife><novel><out-of-pocket costs><out-of-pocket health care costs><outpatient treatment><pandemic><pandemic disease><poor health outcome><premature><prematurity><prevent><preventing><race based disparity><race based inequality><race based inequity><race disparity><race related disparity><race related inequality><race related inequity><racial><racial background><racial disparity><racial inequality><racial inequity><racial origin><racially unequal><reduced health outcome><response><secondary analysis><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><sex><shocks><telehealth><total medical expenditure><vulnerable group><vulnerable individual><vulnerable people><waiver><worse health outcome>