J. Frank Wharam, M.D., M.P.H., studies the effect of insurance benefits on health outcomes and is an expert in the analysis of health insurance claims data. As Director of the Division of Health Policy and Insurance Research in the Department of Population Medicine at Harvard Medical School, Dr. Wharam leads projects examining the consequences of high-deductible health plans, including for breast cancer patients and on diabetes quality, outcomes and disparities. Dr. Wharam also cares for patients as a general internist in the Atrius Health system.
The Betsy Lehman Center: What do you see in your research about the downstream effects of high-deductible health plans? Are patients being harmed inadvertently because the implications of these changes are not well understood?
Dr. Wharam: High-deductible plans have grown steadily for more than a decade. You’d hope that by now we’d have good data about the health effects, but we don't.
Earlier studies have given us an understanding of how these plans affect members’ use of health services. But I wanted to know if high-deductible insurance affects health outcomes, if it makes people sicker. So far, my research group has published two studies [here and here] where we tried very hard to determine if high-deductible plans resulted in unintended, adverse health outcomes. Both studies focused on people with diabetes. Taken together, the two studies show a disparity in the effect of an employer-mandated switch to high-deductible plans; low-income patients appear to have adverse health outcomes, and higher-income patients do not.