High-deductible health plans: are vulnerable families enrolled?
High-deductible health plans: are vulnerable families enrolled?
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DOI：
10.1542/peds.2008-1738
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发表时间：
2009-04
期刊：
影响因子：
8
通讯作者：
Lieu TA
中科院分区：
文献类型：
--
作者：
Galbraith AA;Ross-Degnan D;Soumerai SB;Miroshnik I;Wharam JF;Kleinman K;Lieu TA
有人担心，高免赔额医疗计划可能对弱势群体产生负面影响。这项研究的目的是比较有孩子的家庭的特点，他们转向高免赔额的健康计划与那些保持传统计划。这项双队列研究包括那些有18岁以下孩子的家庭，这些家庭通过没有提供健康计划选择的雇主参加了马萨诸塞州的健康计划。我们确定了在2001年至2004年12个月的基准期间拥有传统健康维护组织计划的家庭，并将其覆盖范围随后被雇主转换为高免赔额健康计划的家庭与雇主选择保留传统计划（对照）的类似家庭进行了比较。数据来自健康计划登记和索赔数据集以及人口普查数据。我们使用多变量逻辑回归模型来比较切换到高免赔额健康计划的家庭与对照组的特征。我们确定了839个有孩子的家庭，他们的雇主把他们换成了高免赔额的健康计划，还有5133个对照。在拥有大型雇主的家庭中，生活在高度贫困社区的家庭，雇主转向高免赔额医疗计划的调整后几率更高。在雇主规模较小的家庭中，对于子女较多、家庭发病率高于平均水平、基线总支出为7000美元的家庭，雇主转向高免赔额健康计划的调整后几率较低。在大雇主提供单一健康计划的家庭中，来自低收入社区的家庭更有可能转向高免赔额的健康计划。相比之下，小雇主提供单一计划的家庭更有可能转向高免赔额的健康计划，如果他们更健康，基线成本更低。这些发现表明，有孩子参加高免赔额计划的家庭可能代表两个不同的群体，与参加传统计划的家庭相比，一个具有高风险特征，另一个具有低风险特征。
There is concern that high-deductible health plans may have negative effects on vulnerable groups. The objective of this study was to compare the characteristics of families who have children and switch to high-deductible health plans with those who stay in traditional plans. This double-cohort study included families who had children aged <18 years and were enrolled in a Massachusetts health plan through employers who did not offer a choice of health plans. We identified families who had traditional health maintenance organization plans for a 12-month baseline period between 2001 and 2004 and compared families whose coverage was then switched to a high-deductible health plan by their employers with similar families whose employer chose to remain in the traditional plan (controls). Data came from health plan enrollment and claims datasets and census data. We used multivariate logistic regression models to compare the characteristics of families who were switched to high-deductible health plans with controls. We identified 839 families who had children and whose employer switched them to high-deductible health plans and 5133 controls. Among families with large employers, the adjusted odds of the employer switching to a high-deductible health plan were higher for families living in high-poverty neighborhoods. Among families with small employers, the adjusted odds of the employer switching to a high-deductible health plan were lower for families with more children, above-average family morbidity, and baseline total expenditures >$7000. Among families with large employers offering a single health plan, those from low-income neighborhoods are more likely to be switched to high-deductible health plans. In contrast, families with small employers offering a single plan are more likely to be switched to high-deductible health plans if they are healthier and have lower baseline costs. These findings suggest that families with children in high-deductible plans may represent two distinct groups, one with higher-risk characteristics and another with lower-risk characteristics compared with those in traditional plans.
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影响因子：
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作者：
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通讯作者：
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