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    Original Investigation
    Health Policy
    July 24, 2020

    Association Between Switching to a High-Deductible Health Plan and Major Cardiovascular Outcomes

    Author Affiliations
    • 1Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
    • 2Department of Medicine, Duke University School of Medicine, Durham, North Carolina
    • 3Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
    • 4Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
    • 5Harvard Kennedy School, Cambridge, Massachusetts
    • 6National Bureau of Economic Research, Cambridge, Massachusetts
    JAMA Netw Open. 2020;3(7):e208939. doi:10.1001/jamanetworkopen.2020.8939
    Key Points español 中文 (chinese)

    Question  Are high-deductible health plans associated with an increased risk of major cardiovascular events?

    Finding  This cohort study included 156 962 individuals with cardiovascular disease risk factors who experienced mandated enrollment in health insurance plans with high deductibles but relatively low medication costs, a common value-based feature. Members with high-deductible health plans did not have detectable increases in major adverse cardiovascular events compared with 1 467 758 members with low-deductible health plans.

    Meaning  Among patients with cardiovascular disease risk factors in this study, enrollment in typical high-deductible health plans was not associated with increased risk of major adverse cardiovascular events during 4 follow-up years.


    Importance  Most people with commercial health insurance in the US have high-deductible plans, but the association of such plans with major health outcomes is unknown.

    Objective  To describe the association between enrollment in high-deductible health plans and the risk of major adverse cardiovascular outcomes.

    Design, Setting, and Participants  This cohort study examined matched groups before and after an insurance design change. Data were from a large national commercial (and Medicare Advantage) health insurance claims data set that included members enrolled between January 1, 2003, and December 31, 2014. The study group included 156 962 individuals with risk factors for cardiovascular disease who were continuously enrolled in low-deductible (≤$500) health plans during a baseline year followed by up to 4 years in high-deductible (≥$1000) plans with typical value-based features after an employer-mandated switch. The matched control group included 1 467 758 individuals with the same risk factors who were contemporaneously enrolled in low-deductible plans. Data were analyzed from December 2017 to March 2020.

    Exposures  Employer-mandated transition to a high-deductible health plan.

    Main Outcomes and Measures  Time to first major adverse cardiovascular event defined as myocardial infarction or stroke.

    Results  The study group included 156 962 individuals and the control group included 1 467 758 individuals; the mean age of members was 53 years (SD: high-deductible group, 6.7 years; control group, 6.9 years), 47% were female, and approximately 48% lived in low-income neighborhoods. First major adverse cardiovascular events among high-deductible health plan members did not differ relative to controls at follow-up vs baseline (adjusted hazard ratio, 1.00; 95% CI, 0.89-1.13). Findings were similar among subgroups with diabetes (adjusted hazard ratio, 0.93; 95% CI, 0.75-1.16) and with other cardiovascular risk factors (adjusted hazard ratio, 0.93; 95% CI, 0.81-1.07).

    Conclusions and Relevance  Mandated enrollment in high-deductible health plans with typical value-based features was not associated with increased risk of major adverse cardiovascular events.