Opioid Use Disorder Care Presentations After High-deductible Health Plan Enrollment

Area of Science:

• Health Economics
• Public Health
• Addiction Medicine

Background:

• Employer-sponsored health insurance is a primary source of healthcare access for working adults.
• High-deductible health plans (HDHPs) shift costs to consumers, potentially affecting healthcare utilization.
• Opioid use disorder (OUD) is a significant public health crisis requiring timely and accessible treatment.

Purpose of the Study:

• To investigate the association between employer-mandated transitions to HDHPs and the timeliness of OUD-related care presentations.
• To determine if increased cost-sharing in HDHPs influences the diagnosis and treatment-seeking behavior for OUD.

Main Methods:

• A matched time-to-event and difference-in-differences analysis was conducted using national commercial insurance claims data from 2003-2017.
• The study included over 574,000 adults transitioning from low-deductible to HDHPs and over 4.3 million controls.
• Outcomes assessed included OUD-related office visits, buprenorphine fills, high-acuity visits, and high-acuity care days.

Main Results:

• Transitions to HDHPs were not associated with delays in initial OUD-related office visits or buprenorphine fills.
• However, HDHP transitions were linked to delays in OUD-related high-acuity visits (HR 0.86, 95% CI: 0.79-0.93).
• HDHP members showed a significant relative reduction in high-acuity care days compared to the control group.

Conclusions:

• Employer-mandated shifts to HDHPs are associated with delayed and reduced high-acuity care presentations for OUD.
• These delays in accessing timely OUD care could result in poorer health outcomes for affected individuals.
• Policymakers and employers should consider the potential impact of HDHPs on vulnerable populations seeking OUD treatment.