High-Deductible Insurance and Delay in Care
Authors: J. Frank Wharam, Joseph P. Newhouse
Journal: Annals of Internal Medicine (2019)

Letters6 August 2019High-Deductible Insurance and Delay in CareJ. Frank Wharam, MB, BCh, BAO, MPH and Joseph P. Newhouse, PhDJ. Frank Wharam, MB, BCh, BAO, MPHHarvard Medical School and Harvard Pilgrim Health Care Institute, Boston Massachusetts (J.F.W.)Search for more papers by this author and Joseph P. Newhouse, PhDHarvard Medical School, Boston, Massachusetts (J.P.N.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0205 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Drs. Goulet and Goldstein are concerned that we excluded patients with MI and CVA from the analysis and that doing so “could have detracted from the validity of [our] findings.” However, we did not exclude such patients; rather, our numerator measures did not include MI and stroke for several reasons.Recent research has shown that delayed care may be a key factor causing adverse events among patients with high-deductible insurance (1). Our study thus aimed to examine care for macrovascular disease that patients could delay, such as visits for symptoms or testing. We hypothesized that having high-deductible insurance ...References1. Wharam JF, Zhang F, Eggleston EM, et al. Diabetes outpatient care and acute complications before and after high-deductible insurance enrollment: a natural experiment for translation in diabetes (NEXT-d) study. JAMA Intern Med. 2017;177:358-68. [PMID: 28097328] doi:10.1001/jamainternmed.2016.8411 CrossrefMedlineGoogle Scholar2. Magid DJ, Koepsell TD, Every NR, et al. Absence of association between insurance copayments and delays in seeking emergency care among patients with myocardial infarction. N Engl J Med. 1997;336:1722-9. [PMID: 9180090] CrossrefMedlineGoogle Scholar3. Newhouse JP. Free for All? Lessons from the RAND Health Insurance Experiment. Cambridge, MA: Harvard Univ Pr; 1993. Google Scholar4. Wharam JF, Landon BE, Galbraith AA, et al. Emergency department use and subsequent hospitalizations among members of a high-deductible health plan. JAMA. 2007;297:1093-102. [PMID: 17356030] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston Massachusetts (J.F.W.)Harvard Medical School, Boston, Massachusetts (J.P.N.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-3365. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoHigh-Deductible Insurance and Delay in Care for the Macrovascular Complications of Diabetes J. Frank Wharam , Christine Y. Lu , Fang Zhang , Matthew Callahan , Xin Xu , Jamie Wallace , Stephen Soumerai , Dennis Ross-Degnan , and Joseph P. Newhouse High-Deductible Insurance and Delay in Care Michael Goulet and Jennifer Goldstein Metrics 6 August 2019Volume 171, Issue 3Page: 226KeywordsAdverse eventsDisclosureSigns and symptomsStroke ePublished: 6 August 2019 Issue Published: 6 August 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...