High-Deductible Health Plans Can Harm COPD Patients: Study

As a rule, high-deductible health plans carry lower premiums than low-deductible plans. But that might not be such a great deal for patients struggling with chronic obstructive pulmonary disease (COPD), new research suggests.

Such plans may be impacting the quality of health care for those with the progressive lung disease, researchers report.

The findings come from an analysis of the U.S. National Health Interview Survey (NHIS) taken between 2011 and 2017. Researchers compared the health care experiences of COPD patients covered by high-deductible plans with those insured under "traditional" private plans.

Plans with deductibles of $1,300 or more for individuals, or $2,600 or more for families were deemed "high-deductible." Private plans either had no deductible or deductibles below those thresholds.

"We found that relative to patients with low or no deductibles, those with high deductibles skipped medications because of cost, avoided visits to specialists, had more financial worries, spent more out of pocket on medical care, while winding up in the hospital more often," said study author Dr. Adam Gaffney.

"Similar sorts of effects have been seen for patients with other chronic illnesses," said Gaffney, an instructor in medicine in the division of pulmonary and critical care medicine at Harvard Medical School and Cambridge Health Alliance in Massachusetts.

Dr. Barbara Yawn, chief science officer at the COPD Foundation in Washington D.C., said, "the results are not surprising.

"Our patients tell us this regularly when we ask about ability to adhere to medication plans or to attend pulmonary rehab," she said.

"Patients with these less expensive plans tell me they often need to choose between food, expenses to get to work, family needs or their medications. They try to get by using less medication, skipping days when they feel a little better or trying to use half as much to make one inhaler go further," she noted.

Yawn, who was not involved in the study, explained that diagnosing and treating a chronic lung illness like COPD can entail significant costs.

For example, despite the fact that smokers account for 75% of COPD patients -- and often display telltale signs such as shortness of breath, coughing, excessive phlegm and extreme fatigue -- a confirmatory spirometry (breathing test) is required. That alone can cost between $100 to $300, she said.

Once diagnosed, patients need an inhaler (bronchodilator), medication for quick relief and an inhalable corticosteroid medication for more extreme situations, alongside other symptom-relief drugs. That regimen can cost up to $350 or more each month, said Yawn.

What's more, a two- to three-month "pulmonary rehabilitation" treatment -- which "is one of the best treatments we have for increasing activity, helping people learn to live with COPD, preventing hospitalizations and dealing with the common co-existing depression and anxiety" -- can run into the several thousands of dollars, Yawn added.

A total of 2,253 patients were included in the survey. All were between 40 and 64, with an average age of 54.

Just over 1,400 had private insurance, while nearly 850 had a high-deductible plan. The two groups were similar in age, gender and income, although those in the high-deductible group were more likely to be white.

After taking into account lifestyle habits, income and additional illnesses, the researchers found that 15% of those with high-deductible plans simply didn't get the care they needed because of cost impediments. That compared with just 7% of those with no/low deductible plans.

More than three-quarters of those in the high-deductible group said they had struggled with medical bill problems, compared to 62% for the low-deductible group. Almost 3 in 10 said they had skipped taking their medications to save money, compared to 19% for the other group.

In the high-deductible group, 16% had ended up hospitalized, compared to 12% in the low-deductible group, and nearly a third ended up seeking care at an ER, compared to 26% in the other group.

"It is important for practicing pulmonologists to be aware of these issues, and of the significant cost barriers that their patients with COPD face," said Gaffney. "The solution, however, is national health care reform. Ensuring that all patients with COPD -- and indeed, all of us -- get the care they need requires a universal health care system without financial barriers like deductibles."

He and his colleagues presented their research Wednesday at the American Thoracic Society annual meeting, in Dallas. Findings presented at scientific meetings are considered preliminary until published in a peer-reviewed journal.

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