Related Experiment Video
Updated: May 26, 2025
Murine Appendectomy Model of Chronic Colitis Associated Colorectal Cancer by Precise Localization of Caecal Patch
Published on: August 24, 2019
Association of High-Deductible Health Plans and Complicated Appendicitis Among Children
Jordan M Rook1,2,3, Lorraine I Kelley-Quon4,5,6, Howard C Jen1
1Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Insights
Children enrolled in high-deductible health plans (HDHPs) face higher rates of complicated appendicitis and increased hospitalization costs. These findings suggest HDHPs may not be suitable for pediatric surgical care, leading to greater expenses.
Area of Science:
- Pediatric Surgery
- Health Economics
- Health Services Research
Background:
- High-deductible health plans (HDHPs) are increasingly common, covering nearly 60% of families with non-governmental employer-sponsored insurance.
- The impact of HDHPs on pediatric surgical care, specifically appendicitis outcomes and costs, remains largely unknown.
Purpose of the Study:
- To investigate the association between high-deductible health plans (HDHPs) and the incidence of complicated appendicitis and associated hospitalization costs in children.
- To evaluate the financial implications of HDHP enrollment for pediatric appendicitis cases.
Main Methods:
- Retrospective cohort study utilizing the 2016-2020 MarketScan dataset.
- Inclusion criteria: children aged 17 and younger with non-governmental employer-sponsored insurance treated for acute appendicitis.
- Analysis involved machine learning-based propensity score weighting and multivariable regression to assess outcomes (complicated appendicitis, hospitalization costs) in relation to HDHP enrollment, controlling for covariates.
Main Results:
- HDHP enrollment was linked to a higher likelihood of complicated appendicitis (33.2% vs. 30.6%).
- Children in HDHPs incurred significantly higher out-of-pocket costs ($4,341 vs. $1,850) and total hospitalization costs ($24,556 vs. $23,852).
- Propensity score weighting ensured covariate balance between HDHP and non-HDHP groups.
Conclusions:
- Pediatric patients with appendicitis enrolled in HDHPs are more likely to experience disease complications and incur greater hospitalization expenses.
- The high cost-sharing inherent in HDHPs may negatively impact pediatric surgical care, increasing overall costs for families and society.
- Findings highlight potential limitations of HDHPs for managing acute pediatric surgical conditions.
Objective:
To determine whether high-deductible health plans (HDHPs) are associated with complicated disease and hospitalization costs for children with appendicitis.
Background:
Nearly 60% of families with non-governmental employer-sponsored insurance are enrolled in HDHPs. It is unknown how these plans affect children who require surgical care.
Methods:
This retrospective cohort study used the 2016 to 2020 MarketScan data set. We included children aged 17 years and younger with non-governmental employer-sponsored insurance who were treated for acute appendicitis. The exposure was a binary variable indicating family enrollment in a HDHP. We assessed the outcomes of complicated appendicitis and hospitalization costs. We used machine learning-based propensity score weights and multivariable regression to assess the association between HDHP enrollment and outcomes. Covariates included age, sex, geographic region, comorbidities, prior health care utilization, and month and year treated.
Results:
Of 18,291 children treated for appendicitis, 40.6% (n = 7434) were enrolled in HDHPs. Groups exhibited covariate balance after propensity score weighting. HDHP enrollment was associated with a 2.6 percentage point (95% CI: 1.2 to 3.9; P < 0.001) increase in the likelihood of presenting with complicated appendicitis (33.2% vs 30.6%), a $2491 (95% CI: $2428 to $2555; P < 0.001) increase in out-of-pocket costs ($4341 vs $1850), and a $703 (95% CI: $185 to $1222; P = 0.008) increase in total costs ($24,556 vs $23,852).
Conclusions:
Children in HDHPs more often present with complicated appendicitis and require more costly hospitalizations. High levels of cost sharing, a dominant component of most private insurance plans, may not serve the needs of children with acute illnesses and can increase costs to patients and society.
Related Concept Videos
01:22Appendicitis-I: Introduction
Etiology: Appendicitis can arise from various causes, primarily rooted in the obstruction of the appendix lumen. Factors contributing to this obstruction include fecal accumulation, lymphoid hyperplasia and, in...
01:29Appendicitis-II: Diagnostic Studies and Management
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
01:30Inflammatory Bowel Disease II: Crohn's Disease
Inflammatory bowel disease, commonly known as IBD, refers to a collection of disorders that lead to persistent inflammation of the gastrointestinal tract. The two types of IBD are ulcerative colitis, which impacts the colon, and Crohn's disease, which can involve any part of the gastrointestinal segment.
Crohn's disease
Crohn's disease is a chronic, systemic inflammatory bowel disease (IBD) that predominantly affects the gastrointestinal tract. It is marked by...
01:26Endoscopic Procedures V: ERCP
Patient...
01:30Acute Pancreatitis II: Clinical Manifestations and Management