Insurance that includes a high deductible tends to cause low-income people with diabetes to forgo medical services, according to a study involving more than 6,500 individuals.

Investigators compared specific measures by income and deductible status in a cohort with diabetes (n=1,461). They also looked at differences in medical debt and delayed/avoided needed care by income in another cohort (n=4,058). Among the results:

• Lower-income respondents with a low deductible were 27% less likely to use primary care services than people with no deductible.
• They were also 39% less likely to have checkups, and 77% less likely to use specialty services.
• Lower-income people with a high deductible saw their service use in these areas decrease 42%, 65%, and 86%, respectively.
• Higher-income respondents with a low deductible used specialty services 28% less and emergency department services 37% less.
• Medical debt was similar by income, but delayed service use was twice as high for people with lower income and medical debt.