Wharam in Circulation: Insurance deductibles may impact ED visits for chest pain

Thursday, July 8, 2021

James ("Frank") Wharam, MD, MPH, is the senior author on a recent publication in the journal Circulation, which found that people with high-deductible health insurance plans are less likely to seek emergency department care for chest pain than those with low-deductible health insurance plans. Dr. Wharam joined Duke GIM faculty earlier this month. He came from Harvard Medical School where he was the director of the Division of Health Policy and Insurance Research.

The research team evaluated health claims from a nationwide U.S. health insurer of more than 5 million people between the ages of 19-63. Of those patients, over half a million were offered a low-deductible health plan in the first year and then were required to switch to a high-deductible plan in the second year. The comparison group stayed enrolled in a low-deductible plan for two years. 

"We were interested in whether high-deductible health plans change cardiovascular outcomes following chest pain emergency department visits,” explains Wharam. "We found no change in use of services such as testing for coronary artery disease, but lower income enrollees of high-deductible plans had higher rates of myocardial infarction in the post-visit month than counterparts in low-deductible plans."

These findings suggest that low-income enrollees in high-deductible plans might be delaying important cardiovascular disease care that affects health outcomes. Policy makers and employers should consider options for reducing cost barriers to life-saving care for low-income members of high-deductible health plans.

About Dr. Wharam
Dr. Wharam has leading expertise on the effects of commercial health insurance designs such as high-deductible health plans (HDHP), consumer-directed health plans (CDHP), and value-based insurance designs (VBID). He uses rigorous study designs to determine how health policies and system interventions affect healthcare quality and outcomes, especially among vulnerable populations. His studies have focused on low-income patients, users of opioids, and individuals with diabetes, cardiovascular disease, cancer, and bipolar disorder. He has expertise in analyzing natural experiments, quasi-experimental research design, and using large administrative databases to conduct observational studies.

Chou SC, Hong AS, Weiner SG, Wharam JF. Impact of High-Deductible Health Plans on Emergency Department Patients With Nonspecific Chest Pain and Their Subsequent Care. Circulation. 2021 Jun 28. doi: 10.1161/CIRCULATIONAHA.120.052501. Online ahead of print. PMID: 34176279