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High-Deductible Health Plan Switches Didn't Lead to More Heart Risk

Analysis  |  By Alexandra Wilson Pecci  
   July 27, 2020

Although the "findings provide a measure of reassurance" about high-deductible health plans, the authors of a new study stopped short of fully endorsing such plans.

Patients with cardiovascular disease risk factors who switched to high-deductible health plans (HDHPs) did not experience increased risk of heart attack or stroke, according to research led by the Harvard Pilgrim Health Care Institute.

The JAMA Network Open study, "Association Between Switching to a High-deductible Health Plan and Major Cardiovascular Outcomes," is the first to examine the association between high out-of-pocket costs and adverse cardiovascular events.

The researchers examined the effects of a transition to a HDHP on the risk of major adverse cardiovascular outcomes.

The study population included 156,962 individuals with cardiovascular disease risk factors who experienced mandated enrollment in health insurance plans with high deductibles but relatively low medication costs.

These patients were members of low-deductible (≤ $500) health plans during a baseline year followed by up to four years in high-deductible (≥$1000) plans after an employer-mandated switch.

The matched control group included 1,467,758 members with the same risk factors who were enrolled in low-deductible plans at the same time.

Study findings show that HDHP members did not experience an increase in major adverse cardiovascular events compared with individuals in low-deductible plans.

"Based on previous high-deductible health plan research, we had hypothesized that those with risk factors for cardiovascular disease would experience increases in major adverse cardiovascular events after a switch to high-deductible health plans, but this did not turn out to be the case," Frank Wharam, lead author and associate professor of population medicine at the Harvard Pilgrim Health Care Institute and Harvard Medical School, said in a statement.

In addition, the "study detected small changes in cardiovascular medication use and preventive services which may have protected HDHP members from increased adverse cardiovascular events," he said.

The authors write that their "findings provide a measure of reassurance that HDHP enrollment was not associated with an appreciable increased risk of major adverse cardiovascular outcomes during 4 follow-up years."

However, they still rang a note of caution, writing that " policymakers and employers should remain cautious in promoting HDHPs among low-income and other vulnerable patients given the potential for adverse financial and health outcomes that this study did not address."

They also said that more time and research was needed, not only to examine long-term outcomes, but also "whether people with HDHPs ultimately require more intensive workups and more advanced treatments for cardiovascular events."

Alexandra Wilson Pecci is an editor for HealthLeaders.

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