# Impact of Health Deductible Health Plans on the Evaluation, Treatment, and Outcomes for Acute Coronary Syndrome

> **NIH NIH K23** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2024 · $167,777

## Abstract

PROJECT ABSTRACT
This K23 award will enable the candidate, Shih-Chuan Chou, MD, MPH, SM, to become an independent
physician-scientist focused on the effect of out-of-pocket costs on care utilization and outcomes of acute chest
pain and cardiovascular care. Chest pain is one of the most common reasons for emergency department (ED)
evaluation, with over 7 million visits annually. ED visits ensure the timely identification and treatment of acute
myocardial infarction (AMI) or acute coronary syndrome (ACS). However, the financial implications of care
have escalated over the past two decades with the growth of high deductible health plans (HDHP). By 2020,
nearly 6 in 10 US employees with employer-sponsored insurance will have deductibles of ≥$1,000. While
research has begun to explore HDHP’s effect on cancer screening and chronic disease management, little
research has examined how it affects acute cardiovascular care. In a preliminary study, Dr. Chou found that
HDHP enrollment reduced ED visits for non-specific chest pain but increased AMI after chest pain admission
among the lower-income population. In this K23, Dr. Chou will further extend this research with 3 proposed
aims. Aim 1 will use segmented survival analysis in a large commercial claims database to examine whether
employer-mandated HDHP enrollment negatively impacted AMI outcomes. Using the same database, aim 2
will utilize the natural randomization of patients to ED clinicians within each ED to determine whether HDHP
reduces low-value chest pain admissions among clinicians with high admitting tendencies. Lastly, aim 3 will
include patient surveys and interviews to elicit chest pain and AMI patients’ perspectives on how high out-of-
pocket costs affected their decisions to seek care, perceived care quality, and subsequent financial impact. All
aims will further focus on low-income patients that face disproportionate financial stress. Dr. Chou proposed a
comprehensive career development curriculum to complement these aims, consisting of extensive didactic and
experiential learning. Dr. Chou has assembled an interdisciplinary team of mentors with recognized expertise
in quasi-experimental observational studies, insurance benefit design, cardiovascular emergencies, health care
disparities, and emergency medicine, who will provide him with intensive mentorship in these topics. The
proposed research and career development activities will allow Dr. Chou to establish his expertise in
insurance-related policies, the financial burden of care, and their impact on the use and outcomes of patients
with acute cardiovascular conditions. This award will enable Dr. Chou to transition into an independent
clinician-scientist focusing on the short- and long-term impact of high out-of-pocket costs and the implications
around the growing implementation of price transparency and cost discussions for acute unscheduled care
visits. Completing the proposed research will generate robust evidence to advance the unde...

## Key facts

- **NIH application ID:** 10903823
- **Project number:** 5K23HL164970-02
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Shih-Chuan Chou
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $167,777
- **Award type:** 5
- **Project period:** 2023-08-09 → 2028-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10903823

## Citation

> US National Institutes of Health, RePORTER application 10903823, Impact of Health Deductible Health Plans on the Evaluation, Treatment, and Outcomes for Acute Coronary Syndrome (5K23HL164970-02). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10903823. Licensed CC0.

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