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High-Deductible Insurance Plans Create Barriers to COPD Care


Patients with chronic obstructive pulmonary disease who have high-deductible health insurance plans may be more likely to avoid essential care due to costs compared to those who have low- or no-deductible plans.

Patients with chronic obstructive pulmonary disease (COPD) covered by high-deductible health insurance plans (HDHP) were more likely to avoid essential care due to costs compared to those with traditional low- or no-deductible plans, according to an abstract presented at the 2019 American Thoracic Society (ATS) International Conference, held May 17-22 in Dallas, Texas.

COPD is the fourth leading cause of death in the United States.1 While effective treatment can improve quality of life and lessen symptoms, financial barriers may impede access to medical care and lead to worse health outcomes.2

Researchers examined data from National Health Interview Surveys (NHIS) conducted between 2011 to 2017. They identified 2253 privately insured adults between 40 to 64 years old who self-reported diagnoses of chronic bronchitis, COPD, or emphysema. Of the total, 1404 had traditional health plans while 849 had HDHPs. Individual health insurance plans with deductibles of $1300 or more and family plans with deductibles of $2600 or more were classified as HDHPs by NHIS in 2017. All patients included in the study were similar in age, gender, overall health, and most other demographic characteristics. Compared to those with traditional plans, individuals with HDHPs were more likely to be white and were slightly more likely to only have a high school degree. All patients also had similar incomes.

Primary outcomes in the study included cost-related deferral of medical care, problems with medical bills, non-adherence to medication due to financial constraints, emergency room visits, and hospitalizations. Researchers compared patients covered by HDHPs to those who had traditional plans. They also performed multivariable linear probability regression analyses, adjusting for demographics, socioeconomic status, health behaviors, comorbidities, and health status, to examine the association of HDHPs with study outcomes.

In unadjusted analyses, the study found:

  • 15.0% of individuals with HDHPs, compared to 6.9% with traditional plans, reported foregoing care due to costs, which was considered significant
  • 77.0% of individuals with HDHPs, compared to 62.3% with traditional plans, reported a problem with medical bills
  • 28.8% of individuals with HDHPs, compared to 19.1% with traditional plans, reported any cost-related medication non-adherence
  • 31.9% of individuals with HDHPs, compared to 26.4% with traditional plans, reported visiting an emergency room at least once in the last year
  • 15.9% of individuals with HDHPs, compared to 12.0% with traditional plans, reported being hospitalized at least once in the last year.

Multivariable models that were fully adjusted produced similar findings.

“High-deductible plans may have harmful consequences in patients with COPD, including greater financial stress, reduced healthcare access, and worse outcomes,” researchers said. “Health system reform that reduces or eliminates financial barriers to care could improve the health of patients with COPD.”


1. Sullivan J, Pravosud V, Mannino DM, Siegel K, Choate R, Sullivan T. National and state estimates of COPD morbidity and mortality - United States, 2014-2015. Chronic Obstr Pulm Dis. 2018; 5(4): 324-333. doi: http://doi.org/10.15326/jcopdf.5.4.2018.0157.

2. Kotsiou OS, Zouridis S, Kosmopoulos M, Gourgoulianis KI. Impact of the financial crisis on COPD burden: Greece as a case study. European Respiratory Review. 2018;27(147). doi: 10.1183/16000617.0106-2017

3. Gaffney AW, White AC, Woolhandler S, et al. Effect of high-deductible health plans on healthcare access, financial strain, medication adherence, and outcomes for patients with COPD: findings from the National Health Interview Survey. Presented at 2019 American Thoracic Society International Conference; May 17-22, 2019, Dallas, TX. https://www.abstractsonline.com/pp8/#!/5789/presentation/22646. Accessed May 20, 2019.

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