Original Study: Association of High-Deductible Health Plans and Complicated Appendicitis among Children

Objective: To determine whether high-deductible health plans (HDHPs) are associated with complicated disease and hospitalization costs for children with appendicitis. Background: Nearly 60% of families with non-governmental employer-sponsored insurance are enrolled in high-deductible health plans (HDHPs). It is unknown how these plans affect children who require surgical care. Methods: This retrospective cohort study used the 2016-2020 MarketScan dataset. We included children aged 17 years and younger with non-governmental employer-sponsored insurance who were treated for acute appendicitis. The exposure was a binary variable indicating family enrollment in a HDHP. We assessed the outcomes of complicated appendicitis and hospitalization costs. We used machine learning-based propensity score weights and multivariable regression to assess the association between HDHP enrollment and outcomes. Covariates included age, gender, geographic region, comorbidities, prior healthcare utilization, and month and year treated. Results: Of 18,291 children treated for appendicitis, 40.6% (n=7,434) were enrolled in HDHPs. Groups exhibited covariate balance after propensity score weighting. HDHP enrollment was associated with a 2.6 percentage point (95%CI, 1.2-3.9; P <0.001) increase in the likelihood of presenting with complicated appendicitis (33.2% versus 30.6%); a $2,491 (95%CI, $2,428-$2,555; P <0.001) increase in out-of-pocket costs ($4,341 versus $1,850); and a $703 (95%CI, $185-$1,222; P =0.008) increase in total costs ($24,556 versus $23,852). Conclusions: Children in HDHPs more often present with complicated appendicitis and require more costly hospitalizations. High levels of cost sharing, a dominant component of most private insurance plans, may not serve the needs of children with acute illnesses and can increase costs to patients and society.