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High deductibles impair access and financial security of COPD patients

October 11, 2019

Topics: Quote of the Day

By Adam Gaffney, Alexander White, Laura Hawks, David Himmelstein, Steffie Woolhandler, David C Christiani, and Danny McCormick
Annals of the American Thoracic Society, October 10, 2019


Rationale: Medical treatment can improve quality of life and avert exacerbations for those with chronic obstructive pulmonary disease (COPD). High-deductible health plans (HDHPs) can increase exposure to medical costs, and might compromise healthcare access and financial well-being for patients with COPD.

Objectives: To examine the association of HDHPs with healthcare access, utilization, and financial strain among individuals with COPD.

Methods: We analyzed privately-insured adults aged 40-64 with COPD in the 2011-2017 National Health Interview Survey, which uses Internal Revenue Service-specified thresholds to classify health plans as “high” or “traditional” deductible coverage. We assessed the association between enrollment in a high deductible plan and indicators of cost-related impediments to care, financial strain, and healthcare utilization, adjusting for potential confounders.

Results: Our sample included 803 individuals with a HDHP and 1,334 with a traditional plan. The two groups’ demographic and health characteristics were similar. Individuals enrolled in a HDHP more frequently reported delayed or foregone care, cost-related medication non-adherence, medical bill problems, and financial strain. They also more frequently reported out-of-pocket healthcare spending in excess of $5,000 a year. While the two groups’ office visit rates were similar, those enrolled in a HDHP were more likely to report a hospitalization or ER visit in the past year.

Conclusions: For patients with COPD, enrollment in a HDHP was associated with cost-related barriers to care, financial strain, and more frequent ER visits and hospitalizations.


Patients with chronic obstructive pulmonary disease and high deductible health plans forgo needed care because of cost, struggle to pay medical bills, and face worse health outcomes: Harvard study

Physicians for a National Health Program, Press Release, October 10, 2019

“COPD is not an easy disease to live with,” noted lead author Dr. Adam Gaffney, a pulmonary and critical care physician and an instructor in medicine at Harvard Medical School and president of Physicians for a National Health Program. “But treatment can help, assuming patients can afford it. Yet our study shows that patients with COPD who are privately insured, especially those with high deductibles, aren’t getting the care they need — with dangerous consequences for their health.”



By Don McCanne, M.D.

Can we make a couple of assumptions?

Everyone should have health care when needed.

Our policies should be designed to ensure access to that care.

Financial barriers impair access to care.

Establishing a universal risk pool that is funded equitably based on ability to pay would remove financial barriers to care (e.g., the single payer model of Medicare for All).

So why do we then erect new financial barriers to care in the form of high deductibles and other cost sharing that clearly have a detrimental effect on health care access and on personal finances?

It defies logic unless you think that the first assumption is wrong – that not everyone should have health care when needed. If you believe that then what criteria should determine which individuals should be left out? Of the many considerations, why select those with inadequate income or wealth to be denied care? Why should society target them for ill health and further financial hardship? What happened to social solidarity?

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

About the Commentator, Don McCanne

Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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