Evidence map›Paper›PMID 37659697›Full record

ArticleJournal of substance use and addiction treatment2023

Choice of high-deductible health plans among enrollees with a substance use disorder.

Mark K Meiselbach, Haiden A Huskamp, Julia C P Eddelbuettel, Alene Kennedy-Hendricks, Mara A G Hollander, Cameron Schilling, Alisa B Busch, Elizabeth A Stuart, Colleen L Barry, Matthew D Eisenberg

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of substance use and addiction treatment, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.2field-weighted citation impact, top 41% of its field
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 5 institutions in 1 country.

Mark K MeiselbachDepartment of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America. Electronic address: mark.meiselbach@jhu.edu.
Haiden A HuskampDepartment of Health Care Policy, Harvard Medical School, Boston, MA, United States of America.
Julia C P EddelbuettelDepartment of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America; PhD Program in Health Policy, Harvard University, Cambridge, MA, United States of America.
Alene Kennedy-HendricksDepartment of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
Mara A G HollanderDepartment of Public Health Sciences, University of North Carolina - Charlotte, Charlotte, NC, United States of America.
Cameron SchillingDepartment of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
Alisa B BuschDepartment of Health Care Policy, Harvard Medical School, Boston, MA, United States of America; McLean Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America.
Elizabeth A StuartDepartment of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
Colleen L BarryCornell Jeb E. Brooks School of Public Policy, Ithaca, NY, United States of America.
Matthew D EisenbergDepartment of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America; Johns Hopkins Carey Business School, Baltimore, MD, United States of America.
Johns Hopkins University · USHarvard University · USCornell University · USUniversity of North Carolina at Charlotte · USWilliam Carey University · US

Funding

Research Support CoreP30DA035772 · NIDA · BRANDEIS UNIVERSITY · PI Haiden A Huskamp, SHARON REIF · 2015 to 2026
$11.3M
TRAINING IN HEALTH SERVICES RESEARCHT32HS000029 · AHRQ · JOHNS HOPKINS UNIVERSITY · PI DY, SYDNEY MORSS · 1987 to 2024
$8.3M
Consumer-Directed Health Plans and Substance Use Disorder TreatmentR01DA044201 · NIDA · JOHNS HOPKINS UNIVERSITY · PI BARRY, COLLEEN L, EISENBERG, MATTHEW · 2018 to 2021
$2.9M
Mental Health Services and Systems Training ProgramT32MH109436 · NIMH · JOHNS HOPKINS UNIVERSITY · PI Matthew Eisenberg, Elizabeth A. Stuart · 2017 to 2026
$1.7M
AHRQ HHS T32 HS000029NIDA NIH HHS P30 DA035772NIDA NIH HHS R01 DA044201NIMH NIH HHS T32 MH109436
6 · The paper itself

Abstract

introductionHigh-deductible health plans (HDHPs) expose enrollees to increased out-of-pocket costs for their medical care, which can exacerbate the undertreatment of substance use disorders (SUDs). However, the factors that influence whether an enrollee with SUD chooses an HDHP are not well understood. In this study, we examine the factors associated with an individual with an SUD's decision to enroll in an HDHP.

methodsUsing de-identified administrative commercial claims and enrollment data from OptumLabs (2007-2017), we identified individuals at employers offering at least one HDHP and one non-HDHP plan. We modeled whether an enrollee chose an HDHP using linear regression on plan and enrollee demographic characteristics. Key plan characteristics included whether a plan had a health savings account (HSA) or a health reimbursement arrangement (HRA). Key demographic variables included age, race/ethnicity, census block income range, census block highest educational attainment, and sex. We separately investigate new enrollment decisions (i.e., not previously enrolled in an HDHP) and re-enrollment decisions, as well as decisions among single enrollees and families of differing sizes. The study also adjusted models for additional plan characteristics, employer and year fixed effects, and census division. Robust standard errors were clustered at the employer level.

resultsThe sample comprised 30,832 plans and 318,334 enrollees. Among enrollees with new enrollment decisions, 24.6 % chose an HDHP; 93.8 % of HDHP enrollees chose to re-enroll in an HDHP. The study found the presence of a plan HRA to be associated with a higher probability of new and re-enrollment in an HDHP. We found that older enrollees with SUD were less likely to newly enroll in an HDHP, while enrollees who were non-White, living in lower-income census blocks, and living in lower educational attainment census blocks were more likely to newly enroll in an HDHP. Higher levels of health care utilization in the prior year were associated with a lower probability of newly enrolling in an HDHP but associated with a higher probability of re-enrolling.

conclusionGiven the emerging evidence that HDHPs may discourage SUD treatment, greater HDHP enrollment could exacerbate health disparities.

Indexed as

Health Benefit Plans, EmployeeSubstance-Related DisordersDeductibles and CoinsuranceHealth PlanningHumansPatient Acceptance of Health CareDeductiblesDisparitiesFamily coverageHealth care spendingPlan choiceSubstance use disorders

Identifiers

PMID37659697
PMCPMC10565842
OpenAlexW4386333348

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

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.