Impact of High Deductible Health Plans on Diabetes Care Quality and Outcomes: Systematic Review

Endocr Pract. 2021 Nov;27(11):1156-1164. doi: 10.1016/j.eprac.2021.07.001. Epub 2021 Jul 7.


Objective: To provide a review of the impact of high deductible health plans (HDHPs) on the utilizations of services required for optimal management of diabetes and subsequent health outcomes.

Methods: Systematic literature review of studies published between January 1, 2000, and May 7, 2021, was conducted that examined the impact of HDHP on diabetes monitoring (eg, recommended laboratory and surveillance testing), routine care (eg, ambulatory appointments), medication management (eg, medication initiation, adherence), and acute health care utilization (eg, emergency department visits, hospitalizations, incident complications).

Results: Of the 303 reviewed articles, 8 were relevant. These studies demonstrated that HDHPs lower spending at the expense of reduced high-value diabetes monitoring, routine care, and medication adherence, potentially contributing to the observed increases in acute health care utilization. Additionally, patient out-of-pocket costs for recommended screenings doubled, and total health care expenditures increased by 49.4% for HDHP enrollees compared with enrollees in traditional health plans. Reductions in disease monitoring and routine care and increases in acute health care utilization were greatest in lower-income patients. None of the studies examined the impact of HDHPs on access to diabetes self-management education, technology use, or glycemic control.

Conclusion: Although HDHPs reduce some health care utilization and costs, they appear to do so at the expense of limiting high-value care and medication adherence. Policymakers, providers, and payers should be more cognizant of the potential for negative consequences of HDHPs on patients' health.

Keywords: benefit design; diabetes; health insurance; health outcomes; high deductible health plan.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Deductibles and Coinsurance*
  • Diabetes Mellitus* / epidemiology
  • Diabetes Mellitus* / therapy
  • Health Expenditures
  • Humans
  • Patient Acceptance of Health Care
  • Quality of Health Care