Impact of the 2008-2009 Economic Recession on Screening Colonoscopy Utilization Among the Insured
Impact of the 2008-2009 Economic Recession on Screening Colonoscopy Utilization Among the Insured
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DOI：
10.1016/j.cgh.2011.11.020
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发表时间：
2012-03-01
影响因子：
12.6
通讯作者：
Kappelman, Michael D.
中科院分区：
文献类型：
--
作者：
Dorn, Spencer D.;Wei, David;Kappelman, Michael D.
背景与目的：经济因素可能会影响推荐的预防性服务的使用。我们试图确定最近严重的经济衰退是否与参保人群中筛查结肠镜检查比率的下降有关，并评估自付费用(OOP)与筛查结肠镜检查使用之间的关系。方法：对106个健康计划(IMS LifeLink Health Plan Claims数据库)的管理数据进行分析，确定2005年1月至2007年11月(衰退前)和2007年12月至2009年6月(衰退期)对50岁至的受益人进行结肠镜检查的月率。使用分段回归模型评估经济衰退前和衰退期间筛查结肠镜检查比率的变化，以及筛查和OOP费用之间的关系。结果：与衰退前的趋势相比，在经济衰退筛查期间，结肠镜检查率下降了68.9%/100万人(95%可信区间，-84.6至-53.1；P<；.001)。对整个美国人口的研究估计表明，在经济衰退期间，年龄在50岁到之间的商业保险患者接受的筛查结肠镜检查减少了大约500,000次。与低OOP成本的人相比，OOP程序成本高的人在经济衰退之前和期间的筛查率较低，并且在经济衰退期间筛查率的下降幅度更大(P<；.035)。结论：在2007年12月至2009年6月的经济衰退期间，与衰退开始前的两年相比，参保个人减少了筛查结肠镜检查的使用。OOP成本与筛查使用呈负相关，特别是在经济衰退期间。减少费用分担的政策可以增加对推荐的预防性服务的遵守，如结肠镜检查。
BACKGROUND & AIMS: Economic factors might affect the use of recommended preventative services. We sought to determine whether the recent severe economic recession was associated with diminished screening colonoscopy rates among an insured population and to assess the relationship between out-of-pocket (OOP) costs and screening colonoscopy use. METHODS: Administrative data from 106 health plans (IMS LifeLink Health Plan Claims Database) were analyzed to determine monthly rates of screening colonoscopies performed on beneficiaries ages 50 to 64 years between January 2005 and November 2007 (prerecession), as well as from December 2007 through June 2009 (recession). Segmented regression models were used to evaluate changes in screening colonoscopy rates, as well as the relationship between screening and OOP costs before and during the recession. RESULTS: Compared with prerecession trends, during the recession screening colonoscopy rates decreased by 68.9 colonoscopies/1 million individuals per month (95% confidence interval, -84.6 to -53.1; P < .001). Application of study estimates to the entire US population indicated that during the recession, commercially insured patients aged 50 to 64 years underwent approximately 500,000 fewer screening colonoscopies. Compared with those with low OOP costs, those with high OOP procedure costs had lower rates of screening before and during the recession, and had a greater reduction in screening rates during the recession (P < .035). CONCLUSIONS: During the recession of December 2007 to June 2009, insured individuals reduced their use of screening colonoscopy compared with the 2 years before the recession began. OOP costs were related inversely to screening use, especially during the recession. Policies to reduce cost sharing could increase adherence to recommended preventive services such as colonoscopy examinations.