Health plans

High-deductible health plans associated with delayed hernia repair

According to a new study, patients with inguinal and ventral hernias who are enrolled in a high-deductible health plan (HDHP) may be more likely to delay surgical care due to financial issues and, therefore, have a disease more complex at presentation and require emergency intervention.


Dr Arden Morris

Corresponding study author Arden Morris, MD, Stanford University School of Medicine, California, said Medscape Medical News via email that the hernia surgery delays seen in patients enrolled in an individual HDHP are largely attributed to medical coverage issues.

“Most HDHP enrollees choose these plans because they have modest income or limited means, and they choose more affordable monthly premiums and accept that they will be responsible for higher costs if health care is needed. “, she explained.

Morris added: “When the need arises they may not be able to afford the costs of care immediately, then when care is delayed most health problems with a surgical solution become more acute.”

The search results were published online in JAMA Surgery.

Highlighting the link between HDHP and complicated hernias

In a retrospective cohort analysis of a large database of commercial insurance claims, Morris and colleagues examined the outcomes of 83,281 privately insured patients aged 18 to 63 who underwent ventral hernia surgery or a groin hernia operation between 2016 and 2019.

The study cohort included 27,477 patients enrolled in an HDHP. These patients were significantly younger, were more likely to be enrolled in individual coverage, and had fewer comorbidities than patients enrolled in a traditional health plan.

A total of 21,876 patients had a hernia coded as incarcerated or strangulated, which the researchers said is characteristic of a “complicated” hernia. Among patients enrolled in an HDHP, more than 1 in 4 patients (26.7%) had a complicated hernia, possibly due to delays in simple, elective hernia repair. A smaller proportion (26%) of patients enrolled in the traditional plan group had an incarcerated or strangulated hernia. The authors calculated that people with individual HDHP coverage were 6% more likely to have an incarcerated or strangulated hernia.

In the study, Morris and colleagues did not find a significant association between advanced disease and enrollment in an HDHP with a health savings account (HSA) or among patients with familial HDHP. Investigators explain that an HDHP can work well for patients who can “set aside money for unexpected healthcare expenses” with an HSA.

Despite initial financial concerns for many hernia patients who are enrolled in an HDHP, the postoperative complications associated with late presentation and emergency surgery “end up being much more costly and impacting the ability to return to the work than elective and simple surgical care”. Morris noted.

Regarding future research, Morris said there is a need to investigate “a bit deeper” causation and decision-making in patients enrolled in HDHPs to address their health care needs. health. “According to the National Bankruptcy Forum, medical debt is the number one reason Americans file for bankruptcy,” she said. “We can do better than that.”

Finances as a decisive factor

Robert E. Glasgow, MD, a surgeon at University of Utah Health, Salt Lake City, explained to Medscape Medical News over the phone that the financial risk of medical care for some patients is undoubtedly associated with late presentation and an increased risk of adverse effects, but this problem does not yet have a clear solution.



Dr Robert Glasgow

While these adverse outcomes are important to patients, financial considerations ultimately drive healthcare decision-making in some patients, Glasgow noted. “When people bear the potential financial burden of the cost of their medical care, it plays a big role in their decision whether or not to seek that care,” he said.

Glasgow added that the study results should not discourage some people from having HDHP. “While the implication here is that high-deductible plans for these patients are bad,” he said, “the reality is that these plans are very, very good at getting people the coverage they need. , especially a healthy young person who really needs coverage to avoid catastrophic illness.”

He added that the solution to financial risk is not simple, given the complexity of the US healthcare system. “I don’t think our society is ready to take on that, because it would mean changing the way we provide health care coverage.”

JAMA Surg. Published online April 1, 2022. Abstract

Morris and Glasgow have disclosed no relevant financial relationship.

Brandon May is a freelance medical journalist who has written over 900 articles for medical publications in the US and UK. He resides in downtown Brooklyn, New York. Twitter: @brandonmilesmay.

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