Risk Selection into Consumer-Directed Health Plans: An Analysis of Family Choices within Large Employers
Risk Selection into Consumer-Directed Health Plans: An Analysis of Family Choices within Large Employers
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DOI：
10.1111/1475-6773.12121
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发表时间：
2014-04-01
影响因子：
3.4
通讯作者：
Sood, Neeraj
中科院分区：
文献类型：
--
作者：
McDevitt, Roland D.;Haviland, Amelia M.;Sood, Neeraj
目的确定随着时间的推移，对消费者导向的健康计划（CDHPs）与传统计划的选择程度，以及影响选择和缓和风险选择的因素。除了家庭、选择设置和计划特征之外，预测因素还包括风险评分。额外的模型分层帐户类型或单一登记者与family.Data收集/提取MethodsRisk分数，家庭特征，和登记决策来自医疗索赔和登记文件。与人力资源主管的访谈提供了额外的数据。主要发现CDHP风险评分在第一年是传统计划评分的74%，随着时间的推移，这种差异逐渐缩小。雇主对账户的贡献和员工的保费储蓄促进了CDHP的注册，减少了风险选择。必须积极选择计划增加了CDHP入组，但也增加了风险选择。风险选择是更大的单身比家庭和HRA和HSA为基础的CDHPs.ConclusionsRisk选择之间没有差异是不严重的，它是管理良好。雇主有有效的方法来鼓励CDHP注册，并根据传统计划调整选择。
ObjectiveTo identify the degree of selection into consumer-directed health plans (CDHPs) versus traditional plans over time, and factors that influence choice and temper risk selection.Data Sources/Study SettingSixteen large employers offering both CDHP and traditional plans during the 2004-2007 period, more than 200,000 families.Study DesignWe model CDHP choice with logistic regression; predictors include risk scores, in addition to family, choice setting, and plan characteristics. Additional models stratify by account type or single enrollee versus family.Data Collection/Extraction MethodsRisk scores, family characteristics, and enrollment decisions are derived from medical claims and enrollment files. Interviews with human resources executives provide additional data.Principal FindingsCDHP risk scores were 74 percent of traditional plan scores in the first year, and this difference declined over time. Employer contributions to accounts and employee premium savings fostered CDHP enrollment and reduced risk selection. Having to make an active choice of plan increased CDHP enrollment but also increased risk selection. Risk selection was greater for singles than families and did not differ between HRA and HSA-based CDHPs.ConclusionsRisk selection was not severe and it was well managed. Employers have effective methods to encourage CDHP enrollment and temper selection against traditional plans.