High Deductible Health Plans and Outcomes for Patients with Diabetes: A Realist Review

Objective: This study summarizes current literature on the association between high deductible health plans (HDHPs) and outcomes for patients with diabetes, as well as elucidates factors that may be influencing the association between the two variables.Methods: A rapid realist review was conducted to synthesize empirical studies on the implementation of HDHPs among populations with diabetes. Study outcomes varied but included emergency department visits, outpatient visits, and medication adherence.Results: Sixteen articles were selected for inclusion in the review. Eleven found an association between HDHP enrollment and adverse health outcomes. Across studies, three factors influenced the effects of HDHPs on diabetes patients: income, health literacy, and intentionality of plan choice. Policy solutions to address each of these factors were distilled from the suggestions in each study.Conclusions: These findings elucidate certain factors that should be at the forefront of any discussion on reforming HDHP structure in the United States. This review will inform the scope of future work conducted by the Center for the Business of Health at UNC on the effects of HDHPs. Future research is needed with more specific outcomes measures to confirm that adverse health outcomes are being experienced by vulnerable populations.Bachelor of Science in Public Healt