ArticleDiabetes care2018
Effect of High-Deductible Insurance on High-Acuity Outcomes in Diabetes: A Natural Experiment for Translation in Diabetes (NEXT-D) Study.
Article in Diabetes care, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
28 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Impact of High Deductible Health Plans on Diabetes Care Quality and Outcomes: Systematic Review.Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2021Pooled it
- High-Deductible Health Plan Enrollment and Buprenorphine Dispensing.JAMA network open · 2026Article
- Delay in Diabetes Diagnosis After High-Deductible Health Plan Enrollment: A Pre-Post Study with Control.Journal of general internal medicine · 2026Article
- Healthcare and Nonhealthcare Costs: Youth With Diabetes and Food Insecurity.American journal of preventive medicine · 2026Observational
- What works to reduce socioeconomic inequalities in hospitalisations and readmissions? Systematic review of the equity impacts of population-level, health service and integrative interventions.BMJ public health · 2025Article
- Article
- Deductible imputation in administrative medical claims datasets.Health services research · 2024Article
- Enrollment in High-Deductible Health Plans and Incident Diabetes Complications.JAMA network open · 2024Article
- Acute Diabetes Complications After Transition to a Value-Based Medication Benefit.JAMA health forum · 2024Article
- Association of High-Deductible Health Plans With Health Care Use and Costs for Patients With Cardiovascular Disease.Journal of the American Heart Association · 2023Article
- Racial and Ethnic Disparities in Glycemic Control Among Insured US Adults.JAMA network open · 2023Article
- Risk Factors and Outcomes of Delayed Presentation of Diabetic Retinopathy Patients to a County Hospital.Translational vision science & technology · 2023Article
- Evaluation of High-Deductible Health Plans and Acute Glycemic Complications Among Adults With Diabetes.JAMA network open · 2023Article
- Health Care Utilization Trends Across the Transition Period in a National Cohort of Adolescents and Young Adults With Type 1 Diabetes.Diabetes care · 2022Article
- Changes in excess mortality among adults with diabetes-related end-stage kidney disease: a comparison between the USA and Australia.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2022Article
- Diabetes Microvascular Disease Diagnosis and Treatment After High-Deductible Health Plan Enrollment.Diabetes care · 2022Article
- Time to start addressing (and not just describing) the social determinants of diabetes: results from the NEXT-D 2.0 network.BMJ open diabetes research & care · 2021Article
- Trends in inpatient admissions and emergency department visits for heart failure in adults with versus without diabetes in the USA, 2006-2017.BMJ open diabetes research & care · 2021Article
- Article
- Decreased Antihyperglycemic Drug Use Driven by High Out-of-Pocket Costs Despite Medicare Coverage Gap Closure.Diabetes care · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
Abstract
objectiveHigh-deductible health plans (HDHPs) are now the predominant commercial health insurance benefit in the U.S. We sought to determine the effects of HDHPs on emergency department and hospital care, adverse outcomes, and total health care expenditures among patients with diabetes. RESEARCH DESIGN AND
methodsWe applied a controlled interrupted time-series design to study 23,493 HDHP members with diabetes, aged 12-64, insured through a large national health insurer from 2003 to 2012. HDHP members were enrolled for 1 year in a low-deductible (≤$500) plan, followed by 1 year in an HDHP (≥$1,000 deductible) after an employer-mandated switch. Patients transitioning to HDHPs were matched to 192,842 contemporaneous patients whose employers offered only low-deductible coverage. HDHP members from low-income neighborhoods (
resultsAfter the HDHP transition, emergency department visits declined by 4.0% (95% CI -7.8, -0.1), hospitalizations fell by 5.6% (-10.8, -0.5), direct (nonemergency department-based) hospitalizations declined by 11.1% (-16.6, -5.6), and total health care expenditures dropped by 3.8% (-4.3, -3.4). Adverse outcomes did not change in the overall HDHP cohort, but members from low-income neighborhoods experienced 23.5% higher (18.3, 28.7) high-severity emergency department visit expenditures and 27.4% higher (15.5, 39.2) high-severity hospitalization days.
conclusionsAfter an HDHP switch, direct hospitalizations declined by 11.1% among patients with diabetes, likely driving 3.8% lower total health care expenditures. Proxy adverse outcomes were unchanged in the overall HDHP population with diabetes, but members from low-income neighborhoods experienced large, concerning increases in high-severity emergency department visit expenditures and hospitalization days.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.