Project Summary
Asthma is one of the most common chronic diseases in the United States, affecting 6.8 million children and 18.7 million adults. Despite guidelines, adherence to recommended asthma controller medications is low; cost is an important barrier to adherence. Employers are increasingly adopting high-deductible health plans (HDHPs) that require patients to pay a deductible of at least $1,000 per individual/$2,000 per family each year before insurance will pay for some healthcare services. In HDHPs with Health Savings Accounts (HSAs), most medications and non-preventive care must be paid out of pocket (OOP) until the deductible is reached. The lower premiums of HSA-HDHPs are appealing, but the high level of OOP costs can lead patients to forgo needed care. HSA-HDHPs can exempt preventive care from the deductible, and employers can add Preventive Drug Lists (PDLs), which exempt certain chronic medications from the deductible (including asthma medications), making them free. PDLs have the potential to improve controller medication use, which could prevent negative health outcomes and reduce cost-related trade-offs for families.
The goal of this research is to evaluate the impact of these two important developments in the health insurance market—HSA-HDHPs and PDLs—on medication use and clinical outcomes for adults and children with asthma. To do this, we will first conduct in-depth qualitative interviews with patients with asthma and parents of children with asthma who have employer-based HDHPs and traditional plans. Interviews will collect patient-reported data on how patients and their families navigate their insurance plans and make healthcare decisions when faced with OOP costs.
Findings from the interviews will inform quantitative analyses of data from a large national health plan from 2004–2017. We will select adults and children with asthma whose employer switched them from traditional plans to HSA-HDHPs with or without a PDL. We will employ a rigorous study design that compares changes in asthma medication use, emergency department (ED) visits, hospitalizations, and OOP costs before and after changing plans to those of similar patients who did not switch to a HSA-HDHP. Our study aims to 1) understand healthcare decision making and experiences of families with asthma with HDHPs, 2) examine the impact of HSA-HDHPs with and without PDLs on use of asthma medications and asthma-related ED visits and hospitalizations, 3) examine the extent to which the response to HSA-HDHPs and PDLs is affected by the presence of other family members with asthma or other chronic conditions, and 4) examine the impact of HSA-HDHPs with and without PDLs on OOP costs for patients and families.
The proposed research will help patients, families, employers, and health plans make decisions about health insurance that promote use of high-value health care, reduce adverse health outcomes, and reduce financial burden for families.
Project Details
*All proposed projects are approved subject to a programmatic and budgetary review by PCORI, and the acceptance of PCORI’s contract terms and conditions.