The impact of high-deductible health plans on men and women: An analysis of emergency department care

Katy B. Kozhimannil, Michael R. Law, Cori Blauer-Peterson, Fang Zhang, James Frank Wharam

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

BACKGROUND:: Prior studies show that men are more likely than women to defer essential care. Enrollment in high-deductible health plans (HDHPs) could exacerbate this tendency, but sex-specific responses to HDHPs have not been assessed. We measured the impact of an HDHP separately for men and women. METHODS:: Controlled longitudinal difference-in-differences analysis of low, intermediate, and high severity emergency department (ED) visits and hospitalizations among 6007 men and 6530 women for 1 year before and up to 2 years after their employers mandated a switch from a traditional health maintenance organization plan to an HDHP, compared with contemporaneous controls (18,433 men and 19,178 women) who remained in an health maintenance organization plan. RESULTS:: In the year following transition to an HDHP, men substantially reduced ED visits at all severity levels relative to controls (changes in low, intermediate, and high severity visits of -21.5% [-37.9 to -5.2], -21.6% [-37.4 to -5.7], and -34.4% [-62.1 to -6.7], respectively). Female HDHP members selectively reduced low severity emergency visits (-26.9% [-40.8 to -13.0]) while preserving intermediate and high severity visits. Male HDHP members also experienced a 24.2% [-45.3 to -3.1] relative decline in hospitalizations in year 1, followed by a 30.1% [2.1 to 58.1] relative increase in hospitalizations between years 1 and 2. CONCLUSIONS:: Initial across-the-board reductions in ED and hospital care followed by increased hospitalizations imply that men may have foregone needed care following an HDHP transition. Clinicians caring for patients with HDHPs should be aware of sex differences in response to benefit design.

Original languageEnglish (US)
Pages (from-to)639-645
Number of pages7
JournalMedical care
Volume51
Issue number8
DOIs
StatePublished - Aug 2013

Keywords

  • consumer-driven health care
  • emergency care
  • high-deductible health plan
  • men
  • sex differences
  • women

Fingerprint Dive into the research topics of 'The impact of high-deductible health plans on men and women: An analysis of emergency department care'. Together they form a unique fingerprint.

Cite this