Marcondes Felippe Ottoni, Zhang Fang, Ross-Degnan Dennis, Wharam J Franklin
Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge St, Suite 1600, 02114, Boston, MA, USA.
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
J Gen Intern Med. 2025 Aug 29. doi: 10.1007/s11606-025-09813-y.
High-deductible health plan (HDHP) members face relatively high out-of-pocket (OOP) costs for urgent care, high-acuity care, and secondary prevention. These costs could affect the timing of cardiometabolic disease diagnosis.
To determine whether HDHPs are associated with delays in diabetes diagnosis and increases in health care costs in the period surrounding new diagnoses.
Segmented survival with control group and pre-post with control group.
Members aged 18 to 64 years without diabetes at the beginning of the pre-index period. Characteristics of interest for stratified analyses comprised sex, income, and race/ethnicity.
Employer-mandated transition from low-deductible health plan to HDHP.
Time to first diabetes diagnosis; and total and OOP medical costs in the peri-diagnosis period (from 30 days before to 90 days after first diabetes diagnosis).
In this sample of 346,492 HDHP members and 346,492 matched and weighted controls, the mean (SD) age was 42.3 (13.0) years, and 48.5% were women. The overall and female HDHP groups experienced delays in diabetes diagnosis in the post- versus pre-index period (adjusted hazard ratio, aHR: 0.93 [95% CI 0.88, 0.99] and 0.91 [0.83, 0.99], respectively), compared with controls. These hazard ratios corresponded to delays of 1.7 and 2.1 months compared with median diagnosed control patients. Other HDHP subgroups did not have statistically significant delays. HDHP group members newly diagnosed with diabetes had relative post- versus pre-index increases in total and OOP peri-diagnosis medical costs of 20% (95% CI 1%, 39%) and 51% (95% CI 33%, 60%), respectively, versus controls.
HDHP enrollment was associated with delayed diabetes diagnosis and substantially increased peri-diagnosis total and OOP medical costs. Female HDHP members might be especially at risk. Policymakers should consider reducing OOP costs for key health care services associated with diagnosing diabetes.
高免赔额健康保险计划（HDHP）的参保者在接受紧急护理、高 acuity 护理和二级预防时面临相对较高的自付费用（OOP）。这些费用可能会影响心血管代谢疾病的诊断时机。
确定 HDHP 是否与糖尿病诊断延迟以及新诊断前后期间医疗费用增加有关。
有对照组的分段生存分析和有对照组的前后对照研究。
在索引期之前开始时年龄在 18 至 64 岁之间且无糖尿病的参保者。分层分析感兴趣的特征包括性别、收入和种族/族裔。
雇主强制从低免赔额健康保险计划过渡到 HDHP。
首次糖尿病诊断时间；以及诊断前后期间（从首次糖尿病诊断前 30 天到诊断后 90 天）的总医疗费用和自付医疗费用。
在这个包含 346,492 名 HDHP 参保者和 346,492 名匹配且加权的对照组样本中，平均（标准差）年龄为 42.3（13.0）岁，48.5%为女性。与对照组相比，HDHP 总体组和女性组在索引期后与索引期前相比糖尿病诊断出现延迟（调整后风险比，aHR：分别为 0.93[95%CI 0.88,0.99]和 0.91[0.83,0.99]）。与诊断的对照组患者中位数相比，这些风险比分别对应 1.7 个月和 2.1 个月的延迟。其他 HDHP 亚组没有统计学上显著的延迟。与对照组相比，新诊断为糖尿病的 HDHP 组成员在诊断前后期间的总医疗费用和自付医疗费用相对于索引期后与索引期前分别增加了 20%（95%CI 1%,39%）和 51%（95%CI 33%,60%）。
加入 HDHP 与糖尿病诊断延迟以及诊断前后期间总医疗费用和自付医疗费用大幅增加有关。女性 HDHP 参保者可能尤其面临风险。政策制定者应考虑降低与糖尿病诊断相关的关键医疗服务的自付费用。
