Effect of High-Deductible Insurance on High-Acuity Outcomes in Diabetes: A Natural Experiment for Translation in Diabetes (NEXT-D) Study.
Effect of High-Deductible Insurance on High-Acuity Outcomes in Diabetes: A Natural Experiment for Translation in Diabetes (NEXT-D) Study.
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DOI：
10.2337/dc17-1183
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发表时间：
2018-05
期刊：
影响因子：
16.2
通讯作者：
Ross-Degnan D
中科院分区：
文献类型：
--
作者：
Wharam JF;Zhang F;Eggleston EM;Lu CY;Soumerai SB;Ross-Degnan D
高免赔额健康计划（HDHPs）现在是美国主要的商业健康保险福利，我们试图确定HDHPs对急诊科和医院护理的影响，不良后果，以及糖尿病患者的总医疗保健支出。我们采用受控中断时间序列设计研究了23，493名HDHP糖尿病患者，年龄在12-64岁之间，从2003年到2012年通过大型国家健康保险公司投保。HDHP成员参加了1年的低免赔额（≤ 500美元）计划，随后在雇主强制转换后参加了1年的HDHP（≥ 1，000美元免赔额）。过渡到HDHPs的患者与192，842名同期患者相匹配，这些患者的雇主只提供低免赔额的保险。来自低收入社区的HDHP成员（n = 8，453）是一个感兴趣的亚组。利用措施包括急诊室访问，住院，和总（健康计划加成员自付）的医疗保健支出。替代健康结果指标包括高严重程度急诊科就诊费用和高严重程度住院天数。在HDHP过渡后，急诊就诊率下降了4.0%（95%CI-7.8，-0.1），住院率下降了5.6%（-10.8，-0.5），直接（非急诊部门）住院率下降了11.1%（-16.6，-5.6），总医疗保健支出下降了3.8%（-4.3，-3.4）。在整个HDHP队列中，不良结局没有改变，但来自低收入社区的成员经历了高23.5%（18.3，28.7）的高严重度急诊科就诊费用和高27.4%（15.5，39.2）的高严重度住院天数。HDHP转换后，糖尿病患者的直接住院率下降了11.1%，可能使总医疗保健支出降低3.8%。在HDHP糖尿病患者中，代理不良结局没有变化，但来自低收入社区的成员经历了大的，关于高严重程度的急诊科就诊费用和住院天数的增加。
High-deductible health plans (HDHPs) are now the predominant commercial health insurance benefit in the U.S. We sought to determine the effects of HDHPs on emergency department and hospital care, adverse outcomes, and total health care expenditures among patients with diabetes. We applied a controlled interrupted time–series design to study 23,493 HDHP members with diabetes, aged 12–64, insured through a large national health insurer from 2003 to 2012. HDHP members were enrolled for 1 year in a low-deductible (≤$500) plan, followed by 1 year in an HDHP (≥$1,000 deductible) after an employer-mandated switch. Patients transitioning to HDHPs were matched to 192,842 contemporaneous patients whose employers offered only low-deductible coverage. HDHP members from low-income neighborhoods (n = 8,453) were a subgroup of interest. Utilization measures included emergency department visits, hospitalizations, and total (health plan plus member out-of-pocket) health care expenditures. Proxy health outcome measures comprised high-severity emergency department visit expenditures and high-severity hospitalization days. After the HDHP transition, emergency department visits declined by 4.0% (95% CI −7.8, −0.1), hospitalizations fell by 5.6% (−10.8, −0.5), direct (nonemergency department–based) hospitalizations declined by 11.1% (−16.6, −5.6), and total health care expenditures dropped by 3.8% (−4.3, −3.4). Adverse outcomes did not change in the overall HDHP cohort, but members from low-income neighborhoods experienced 23.5% higher (18.3, 28.7) high-severity emergency department visit expenditures and 27.4% higher (15.5, 39.2) high-severity hospitalization days. After an HDHP switch, direct hospitalizations declined by 11.1% among patients with diabetes, likely driving 3.8% lower total health care expenditures. Proxy adverse outcomes were unchanged in the overall HDHP population with diabetes, but members from low-income neighborhoods experienced large, concerning increases in high-severity emergency department visit expenditures and hospitalization days.
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影响因子：
12.7
作者：
Krieger, N;Chen, JT;Subramanian, SV
通讯作者：
Subramanian, SV
影响因子：
12.7
作者：
Krieger, N;Chen, JT;Subramanian, SV
通讯作者：
Subramanian, SV
影响因子：
9.7
作者：
Haviland, Amelia M.;Marquis, M. Susan;Sood, Neeraj
通讯作者：
Sood, Neeraj
影响因子：
3
作者：
Kozhimannil KB;Law MR;Blauer-Peterson C;Zhang F;Wharam JF
通讯作者：
Wharam JF
影响因子：
3.4
作者：
Fiscella, Kevin;Fremont, Allen M.
通讯作者：
Fremont, Allen M.