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High-deductible health plans: are vulnerable families enrolled?

Abstract：

OBJECTIVE:There is concern that high-deductible health plans may have negative effects on vulnerable groups. The objective of this study was to compare the characteristics of families who have children and switch to high-deductible health plans with those who stay in traditional plans. METHODS:This double-cohort study included families who had children aged <18 years and were enrolled in a Massachusetts health plan through employers who did not offer a choice of health plans. We identified families who had traditional health maintenance organization plans for a 12-month baseline period between 2001 and 2004 and compared families whose coverage was then switched to a high-deductible health plan by their employers with similar families whose employer chose to remain in the traditional plan (controls). Data came from health plan enrollment and claims datasets and census data. We used multivariate logistic regression models to compare the characteristics of families who were switched to high-deductible health plans with controls. RESULTS:We identified 839 families who had children and whose employer switched them to high-deductible health plans and 5133 controls. Among families with large employers, the adjusted odds of the employer switching to a high-deductible health plan were higher for families living in high-poverty neighborhoods. Among families with small employers, the adjusted odds of the employer switching to a high-deductible health plan were lower for families with more children, above-average family morbidity, and baseline total expenditures >$7000. CONCLUSIONS:Among families with large employers offering a single health plan, those from low-income neighborhoods are more likely to be switched to high-deductible health plans. In contrast, families with small employers offering a single plan are more likely to be switched to high-deductible health plans if they are healthier and have lower baseline costs. These findings suggest that families with children in high-deductible plans may represent two distinct groups, one with higher-risk characteristics and another with lower-risk characteristics compared with those in traditional plans.

journal_name

Pediatrics

journal_title

Pediatrics

authors

Galbraith AA,Ross-Degnan D,Soumerai SB,Miroshnik I,Wharam JF,Kleinman K,Lieu TA

doi

10.1542/peds.2008-1738

subject

Has Abstract

pub_date

2009-04-01 00:00:00

pages

e589-94

issue

eissn

0031-4005

issn

1098-4275

pii

123/4/e589

journal_volume

123

pub_type

杂志文章

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High-deductible health plans: are vulnerable families enrolled?