ArticleBMJ open2021
Trends in high deductible health plan enrolment and spending among commercially insured members with and without chronic conditions: a Natural Experiment for Translation in Diabetes (NEXT-D2) Study.
Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
What it found
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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.
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Who cites it
12 citing papers in PubMed, 14 citations in OpenAlex.
- Out-Of-Pocket Expenses of Carpal Tunnel Release.Journal of hand surgery global online · 2026Article
- 1. Improving Care and Promoting Health in Populations: Standards of Care in Diabetes-2026.Diabetes care · 2026Review
- Effects of Adopting Preventive Drug Lists on Medication Costs and Disparities by Income Over 2 Years: A Natural Experiment for Translation in Diabetes (NEXT-D) Study.Diabetes care · 2025Article
- 1. Improving Care and Promoting Health in Populations: Standards of Care in Diabetes-2025.Diabetes care · 2025Review
- Should I Buy Groceries or Get a Diagnostic Scan?Health equity · 2025Article
- The impact of telehealth cost-sharing on healthcare utilization: Evidence from high-deductible health plans.Health services research · 2024Article
- Changes in Healthcare Spending Attributable to High Deductible Health Plan Offer Among Enrollees with Comorbid Substance Use Disorder and Cardiovascular Disease.Journal of general internal medicine · 2024Article
- 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
- Association of High-Deductible Health Plans With Health Care Use and Costs for Patients With Cardiovascular Disease.Journal of the American Heart Association · 2023Article
- Plan Selection, Enrollee Risk, and Health Spending on the Patient Protection and Affordable Care Act Individual Marketplaces, 2019.JAMA network open · 2023Article
- 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
Corrections and comments
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
Abstract
objectivesTo examine trends in high deductible health plan (HDHP) enrolment among members with diabetes and cardiovascular disease (CVD) compared with healthy members and compare out-of-pocket (OOP) and total spending for members with chronic conditions in HDHPs versus low deductible plans.
designDescriptive study with time trends.
settingA large national commercial insurance database.
participants1.2 million members with diabetes, 4.5 million members with CVD (without diabetes) and 18 million healthy members (defined by a low comorbidity score) under the age of 65 years and insured between 2005 and 2013. OUTCOME MEASURES: Percentage of members in an HDHP (ie, annual deductible ≥$1000) by year, annual mean OOP and total spending, adjusted for member sociodemographic and employer characteristics.
resultsEnrolment in HDHPs among members in all disease categories increased by 5 percentage points a year and was over 50% by 2013. On average, over the study period, HDHP enrolment among members with diabetes and CVD was 2.84 (95% CI: 2.78 to 2.90) and 2.02 (95% CI: 1.98 to 2.05) percentage points lower, respectively, than among healthy members. HDHP members with diabetes, CVD and low morbidity had higher annual OOP costs ($636 (95% CI: 630 to 642), $539 (95% CI: 537 to 542) and $113 (95% CI: 112 to 113)) and lower total costs (-$529 (95% CI: -597 to -461), -$364 (95% CI: -385 to -342) and -$79 (95% CI: -81 to -76)), respectively, than corresponding low deductible members when averaged over the study period. Members with chronic diseases had yearly OOP expenditures that were five to seven times higher than healthier members.
conclusionHigh HDHP enrolment coupled with the high OOP costs associated with HDHPs may be particularly detrimental to the financial well-being of people with diabetes and CVD, who have more healthcare needs than healthier populations.
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Registered trials
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