Impact of a high-deductible health plan on outpatient visits and associated diagnostic tests.
Impact of a high-deductible health plan on outpatient visits and associated diagnostic tests.
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DOI：
10.1097/mlr.0000000000000008
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发表时间：
2014-01
期刊：
影响因子：
3
通讯作者：
Wharam JF
中科院分区：
文献类型：
--
作者：
Reddy SR;Ross-Degnan D;Zaslavsky AM;Soumerai SB;Wharam JF
通过将更大比例的自付费用医疗费用转移给消费者，高免赔额健康计划 (HDHP) 可能会阻止使用基本门诊服务。旨在检查 HDHP 对门诊就诊以及相关实验室和放射学测试的影响。我们使用事前对比组研究设计来检查 7953 名从传统 HMO 计划转为 HDHP 的成年人与仍保留传统计划的 7953 名成年人在门诊服务利用率方面的差异变化。 HDHP 成员完全承保预防性实验室检查，并为门诊就诊提供适度的共付额，与对照类似，但在放射学检查和不属于预防性的实验室检查的免赔额下面临全额费用分摊。与对照组相比，HDHP 组的整体就诊次数（IRR 比率 = 0.91，或相对减少 9%；95% 置信区间 0.88，0.94）以及较高优先级（0.91；0.85，0.97）和较低优先级（0.89；0.81，0.99）慢性病的就诊次数出现中度相对下降。急性较高或较低优先级病症（均为 0.93；0.86，1.01）或预防性实验室检测（0.97；0.93，1.02）的就诊率变化没有显着差异。 HDHP 成员在一般实验室测试（0.91；0.86，0.97）的使用方面表现出适度的相对减少，但放射学测试的使用却没有（0.97，0.91，1.03）。尽管预防性实验室和急性就诊保持不变，但 HDHP 成员的慢性门诊就诊人数有所下降。与医疗保健系统接触较多的 HDHP 慢性病患者可能更有可能减少使用，因为与门诊就诊相关的费用增加。
By shifting a greater share of out-of-pocket medical costs to consumers, high-deductible health plans (HDHP) might discourage use of essential outpatient services. To examine the impact of a HDHP on outpatient visits and associated laboratory and radiology tests. We used a pre-post with comparison group study design to examine the differential change in outpatient service utilization among 7953 adults who were switched from a traditional HMO plan to a HDHP compared with 7953 adults remaining in traditional plans. HDHP members had full coverage of preventive laboratory tests and modest copayments for outpatient visits, similar to controls, but faced full cost sharing under the deductible for radiology tests and laboratory tests not classified as preventive. Compared to controls, the HDHP group experienced moderate relative decreases in overall office visits (ratio of IRRs=0.91, or a 9% relative reduction; 95% confidence interval 0.88, 0.94) and visits for higher (0.91; 0.85, 0.97) and lower-priority (0.89; 0.81, 0.99) chronic conditions. There were no significant differences in changes in visit rates for acute higher or lower-priority conditions (both 0.93; 0.86, 1.01) or preventive laboratory tests (0.97; 0.93, 1.02). HDHP members showed moderate relative reductions in the use of general laboratory tests (0.91; 0.86, 0.97) but not radiology tests (0.97, 0.91, 1.03). Chronic outpatient visits declined among HDHP members, although preventive labs and acute visits remained unchanged. HDHP patients with chronic illnesses who have more contact with the health care system might be more likely to reduce utilization because of increased exposure to costs associated with ambulatory visits.