High-Deductible Health Plans and Healthcare Access, Use, and Financial Strain in Those with Chronic Obstructive Pulmonary Disease

Ann Am Thorac Soc. 2020 Jan;17(1):49-56. doi: 10.1513/AnnalsATS.201905-400OC.


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 years 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 an HDHP and indicators of cost-related impediments to care, financial strain, and healthcare utilization, adjusting for potential confounders.Results: Our sample included 803 individuals with an HDHP and 1,334 with a traditional plan. The two groups' demographic and health characteristics were similar. Individuals enrolled in an HDHP more frequently reported delayed or foregone care, cost-related medication nonadherence, medical bill problems, and financial strain. They also more frequently reported out-of-pocket healthcare spending in excess of $5,000 a year. Although the two groups' office visit rates were similar, those enrolled in an HDHP were more likely to report a hospitalization or emergency room visit in the past year.Conclusions: For patients with COPD, enrollment in an HDHP was associated with cost-related barriers to care, financial strain, and more frequent emergency room visits and hospitalizations.

Keywords: chronic obstructive pulmonary disease; healthcare disparities; healthcare financing; medication adherence.

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Deductibles and Coinsurance / economics*
  • Deductibles and Coinsurance / statistics & numerical data
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Health Care Surveys
  • Health Expenditures / statistics & numerical data*
  • Health Planning
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Insurance, Health / economics*
  • Insurance, Health / statistics & numerical data
  • Male
  • Middle Aged
  • Pulmonary Disease, Chronic Obstructive / economics*
  • Pulmonary Disease, Chronic Obstructive / therapy
  • United States