Insurance Transitions and Changes in Physician and Emergency Department Utilization: An Observational Study
Insurance Transitions and Changes in Physician and Emergency Department Utilization: An Observational Study
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DOI：
10.1007/s11606-017-4072-4
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发表时间：
2017-10-01
影响因子：
5.7
通讯作者：
Landon, Bruce E.
中科院分区：
文献类型：
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作者：
Barnett, Michael L.;Song, Zirui;Landon, Bruce E.
鼓励购买健康保险，以此找到最能满足参保者需求的最实惠的保险。然而，人们在多大程度上更换保险以及随后可能出现的医疗保健利用变化，特别是新的医生就诊，还没有得到很好的了解。为了检查保险更换与新医生和急诊科就诊之间的关系，我们采用双重差分设计进行观察性研究，将那些更换保险的保险公司与未更换的倾向评分匹配对照进行比较，并根据个人最初是否有私人或医疗补助保险进行分层。所有分析均根据个人和保险特征进行了调整。2010 年至 2013 年马萨诸塞州拥有私人或医疗补助保险的连续参保非老年人。新的初级保健和专科医生就诊率以及急诊科就诊率。在匹配之前，在 1,628,057 名连续参保个人中，418,231 人 (26%) 在 2 年期间更换了保险公司。匹配后，转换者和非转换者的特征相似（每组 n = 316,343）。匹配后，转换计划与那些最初有医疗补助或私人保险的人转换后新的初级保健医生就诊率分别增加了 203% 和 47.5%（均 p < 0.001），短期内增幅较大，但随着时间的推移而减少。在医疗补助覆盖范围内，转换与转换当月急诊就诊率增加 14.9% 相关 (p < 0.001)，但转换后略有下降。保险转换很常见，并且与公共保险参保人新就诊的增加和急诊使用率的暂时增加相关。随着保险市场在当前政策环境下变得更加不稳定，了解保险转换后利用率的变化可能变得越来越重要。
Shopping for health insurance is encouraged as a way to find the most affordable coverage that best meets an enrollee's needs. However, the extent to which individuals switch insurance and subsequent changes in health care utilization that might arise, particularly new physician visits, are not well understood.To examine the relationship between insurance switching and new physician and emergency department visits around the time of a switch.Observational study using a difference-in-differences design to compare those switching insurance carriers with propensity score-matched controls who did not switch, stratified based on whether individuals initially had private or Medicaid insurance coverage. All analyses adjusted for individual and insurance characteristics.Continuously insured, non-elderly individuals with private or Medicaid insurance coverage in Massachusetts from 2010 to 2013.Rates of new primary care and specialist physician visits, as well as rates of emergency department visits.Before matching, among 1,628,057 continuously insured individuals, 418,231 (26%) switched insurance carriers during a 2-year period. Characteristics of switchers and non-switchers were similar after matching (n = 316,343 in each group). After matching, switching plans was associated with a 203% and 47.5% increase in the rate of new primary care physician visits following switching for those initially with Medicaid or private coverage, respectively (both p < 0.001), with a large short-term increase, diminishing over time. Among those with Medicaid coverage, switching was associated with a 14.9% higher rate of ED visits during the month of switching (p < 0.001), but otherwise decreased modestly after switching.Insurance switching is common, and is associated with increased new physician visits and temporarily increased ED use among the publicly insured. As insurance markets become more volatile in the current policy environment, understanding changes in utilization after insurance switching may become increasingly important.