High-deductible health plans (HDHP) that require large out-of-pocket payments for retinopathy screening and ophthalmologist visits could delay retinopathy screening, retinopathy diagnosis, and vision loss diagnosis. We studied 2004-2014 data in a large commercial and Medicare Advantage claims database. We included a national sample of 39,798 HDHP members with diabetes enrolled for 1 year in a low deductible (≤$500) plan followed by up to 4 years in a HDHP (≥$1000) after an employer-mandated switch. We matched HDHP patients to 305,852 contemporaneous controls whose employers offered only low-deductible plans. Outcomes included time to first: (a) retinopathy screening, (b) diagnosis of mild-to-moderate and (c) severe non-proliferative diabetic retinopathy, and (d) vision loss diagnosis. We used Cox proportional hazards models adjusted for multiple baseline characteristics to estimate baseline and follow-up hazard ratios. At baseline, adjusted hazard ratios (aHRs) between HDHP members and controls were not statistically different. At follow up, HDHP members experienced delays in first retinopathy screening (aHR: 0.89 [085, 0.92]), diagnosis of mild-to-moderate non-proliferative diabetic retinopathy (aHR: 0.82 [0.76, 0.89]), diagnosis of severe non-proliferative diabetic retinopathy (aHR: 0.90 [0.81, 1.00]), and vision loss diagnosis (aHR: 0.93 [0.88, 0.99]). HDHP members with diabetes experienced delayed retinopathy screening, retinopathy diagnosis, and vision loss diagnosis compared with similar patients in more generous health plans. Reducing financial barriers to care might improve retinopathy outcomes.


J. Wharam: None. F. Zhang: None. C. Lu: None. T. Stryjewski: Other Relationship; Self; Aldeyra Therapeutics, Pykus Therapeutics. K. Callaway: None. J. Wallace: None. J.P. Newhouse: None. D. Ross-Degnan: None.


National Institute of Diabetes and Digestive and Kidney Diseases

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