High-deductible Plans Not Associated With Increased Risk for Stroke, Heart Attacks

A new study looking at the association between high out-of-pocket costs and cardiovascular events suggests that switching to a high-deductible plan may not be associated with worse cardiovascular outcomes.

Published in JAMA Network Open, the cohort study included more than 156,000 individuals with cardiovascular disease risk factors who were continuously enrolled in low-deductible ($500 or less) health plans who switched to a high-deductible plan due to employer mandate ($1,000 or more) for four years. The authors also created a matched-control group of 146,758 individuals with the same risk factors who were contemporaneously enrolled in low-deductible plans. Approximately 48% of the study population lived in low-income neighborhoods. The study outcome of interest was the first major adverse cardiovascular event defined as myocardial infarction or stroke.

According to the study results, first major adverse cardiovascular events in the high-deductible cohort did not have different outcomes relative to the matched controls at follow-up versus baseline (adjusted HR=1.00; 95% CI, 0.89 to 1.13). They also reported similar findings in the subgroups. Patients with diabetes (adjusted HR=0.93; 95% CI, 0.75 to 1.16) and also those with other cardiovascular risk factors (adjusted HR=0.93; 95% CI, 0.81 to 1.07) did not show an increased risk for the cardiovascular outcomes compared with controls.

“Based on previous high-deductible health plan research, we had hypothesized that those with risk factors for cardiovascular disease would experience increases in major adverse cardiovascular events after a switch to high-deductible health plans, but this did not turn out to be the case,” said Frank Wharam, lead author and Associate Professor of Population Medicine at the Harvard Pilgrim Health Care Institute and Harvard Medical School, in a press release. “High deductible health plans typically include features such as low or no out-of-pocket costs for medications and preventive services. Our study detected small changes in cardiovascular medication use and preventive services which may have protected high deductible health plan members from increased adverse cardiovascular events.