The impact of HDHPs on service use and spending for substance use disorders.
The impact of HDHPs on service use and spending for substance use disorders.
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DOI：
10.37765/ajmc.2022.89250
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发表时间：
2022-10
期刊：
影响因子：
--
通讯作者：
Barry CL
中科院分区：
文献类型：
--
作者：
Eisenberg MD;Kennedy-Hendricks A;Schilling C;Busch AB;Huskamp HA;Stuart EA;Meiselbach MK;Barry CL
虽然高免赔额健康计划（HDHPs）减少了医疗保健支出，但更高的免赔额可能导致放弃护理。我们的目标是确定HDHPs对SUD服务的使用和支出的影响。我们使用差异中的差异模型来比较在整个研究期间新提供HDHP的登记者与仅提供传统计划选项的登记者之间治疗SUD的服务使用和支出。我们使用OptumLabs®（2007-2017）的去识别商业索赔数据来识别28，717，236人-年（2.2%诊断为SUD）的样本。主要的独立措施是被提供HDHP的指标。主要的依赖性措施是使用SUD服务和特定治疗类型的概率（和相关支出）。与对照组相比，在接受HDHP后，登记者使用SUD服务的可能性降低了6.6%（p<0.001）。减少集中在住院、中间和门诊护理以及药物使用。被提供HDHP与健康计划支出减少21%（p<0.001）和自付支出增加14%（p<0.01）相关。提供HDHP与SUD服务使用的减少以及从计划到登记者的支出转移有关。在美国药物流行的背景下，研究结果强调了一个问题，即向HDHPs的发展可能会加剧SUD的治疗不足。
While high-deductible health plans (HDHPs) reduce healthcare spending, higher deductibles may lead to foregone care. Our goal was to determine the effects of HDHPs on the use of and spending on SUD services. We used difference-in-differences models to compare service use and spending for treating SUD among enrollees who were newly offered a HDHP relative to enrollees only offered traditional plan options throughout the study period. We used de-identified commercial claims data from OptumLabs® (2007-2017) to identify a sample of 28,717,236 person-years (2.2% with a diagnosed SUD). The main independent measure was an indicator for being offered a HDHP. The main dependent measures were the probability of (and spending associated with) using SUD services and specific treatment types. Enrollees were 6.6% (p<0.001) less likely to use SUD services after being offered a HDHP relative to the comparison group. Reductions were concentrated in inpatient, intermediate and ambulatory care, and medication use. Being offered a HDHP was associated with a decrease of 21% (p<0.001) on health plan spending and an increase of 14% (p<0.01) on out-of-pocket spending. Offering a HDHP was associated with a reduction in SUD service use and a shift in spending from the plan to the enrollee. In the context of the US drug epidemic, study findings highlight a concern that the movement towards HDHPs may be exacerbating under-treatment of SUD.
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影响因子：
3.4
作者：
McDevitt, Roland D.;Haviland, Amelia M.;Sood, Neeraj
通讯作者：
Sood, Neeraj
影响因子：
--
作者：
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影响因子：
2
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影响因子：
120.7
作者：
McLellan, AT;Lewis, DC;Kleber, HD
通讯作者：
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影响因子：
3.5
作者：
Eisenberg, Matthew D.;Haviland, Amelia M.;Sood, Neeraj
通讯作者：
Sood, Neeraj