• Health insurance costs rose and a greater financial burden fell on patients.
• Evidence shows that insurance status and financial concerns can cause people to delay or skip care.
• In 2020, approximately 57% of workers in the United States were enrolled in a high-deductible health plan.

New research published this month in the journal found that people with high-deductible health insurance plans are less likely to seek medical care for chest pain than those with health insurance plans. low-deductible disease.

Health insurance costs have increased and, in recent years, a greater financial burden has fallen on the patient.

Evidence shows that insurance status and financial concerns can cause people to delay or skip care.

Patients with lower socioeconomic status are disproportionately affected, both financially and medically.

This study is the first to examine how these concerns specifically affect patients' willingness to go to the emergency room for chest pain – a symptom that can be a sign of an underlying heart problem like coronary artery disease.

“While this is not surprising, it is still very sobering. We must have a rational concept of insurance. And when the design of the policy leads to worse outcomes, that’s a major problem,” said , a professor of radiology and public health at Yale University.

Costs can cause patients to delay and ignore care

Researchers assessed the health care claims of a national U.S. health insurer for more than half a million people aged 19 to 63.

Among patients, more than half a million were offered a low-deductible health plan (defined as $500 or less per year) in the first year and then had to upgrade to a high-deductible plan ( defined as $1 or more per year) in the second year.

The second group of participants, which served as a control group and included about 6 million people, remained enrolled in a low-deductible plan for two years.

Researchers found that switching to the high-deductible health plan was linked to a 4 percent drop in emergency room visits for chest pain.

Additionally, people with high-deductible plans were associated with an 11% decrease in emergency department visits for chest pain that resulted in hospitalization.

Additionally, low-income patients with high-deductible plans were about a third more likely to have a heart attack within 30 days of their first emergency room visit for chest pain.

“Cost is a real factor in patient outcomes. Clinicians should actively consider including costs in our discussions with patients and in shared decision-making. Insurers and employers need to consider how they will manage high-deductible plans in the future, particularly given the impact on their employees' health,” said the study's lead author, emergency physician in the department of emergency medicine at Brigham and Women's Hospital in Boston. In .

How insurance costs impact treatment and care

showed that insurance type and financial concerns influence when and if people seek care for medical problems.

A also found that people who switched to a high-deductible plan had fewer emergency room visits than those who had low-deductible plans.

The change appears to have affected visits only for low-severity health conditions. Additionally, the impact was most pronounced among people with low socioeconomic status.

A found that patients of low socioeconomic status experienced a 25 to 30 percent drop in emergency room visits for high-acuity health conditions after switching to a high-deductible plan.

“People with higher deductibles delay treatment and are sicker when they come to the emergency room with chest pain. When low-income people switch to high-deductible plans, they experience a disproportionate financial impact, as does their health,” Chou said in the release.

Delaying treatment, especially for problems such as chest pain, can have life-threatening consequences.

“There is a saying that ‘time is muscle’. This means that the longer it takes to treat an acute myocardial infarction, the more permanent the damage. We should encourage timely diagnosis and treatment in this setting,” Forman said.

Design health plans to improve patient outcomes

Forman says this effect has been known for years, and health experts hope education and awareness could encourage people to seek care more quickly.

“We had hoped (and still hope) that better consumer information and education can help make better decisions. But that may not be possible in the setting of acute chest pain,” Forman said.

In recent years, patients have assumed more out-of-pocket costs as the price of health insurance plans has increased, often imposing greater financial burdens on patients.

In 2020, approximately 57% of workers in the United States were enrolled in a high-deductible health plan.

Forman says insurance policies should be designed to improve patient outcomes, not make them worse.

“There are new value-based insurance models that seek to strike a more rational balance. We must prioritize the health of the patient before saving money. We can do both, but not with blunt instruments,” Forman said.

The bottom line 

New research has found that people with high-deductible health insurance plans are less likely to seek medical care for chest pain than those with low-deductible health insurance plans. Previous evidence has shown that insurance type and financial concerns can cause patients to delay or skip care, but this is the first to look specifically at chest pain. Out-of-pocket costs have increased for patients in recent years and, in some cases, can lead to worsening health outcomes.

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