The impact of high-deductible health plans on men and women: an analysis of emergency department care.
The impact of high-deductible health plans on men and women: an analysis of emergency department care.
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DOI：
10.1097/mlr.0b013e31829742d0
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发表时间：
2013-08
期刊：
影响因子：
3
通讯作者：
Wharam JF
中科院分区：
文献类型：
--
作者：
Kozhimannil KB;Law MR;Blauer-Peterson C;Zhang F;Wharam JF
先前的研究表明，男性比女性更有可能推迟基本护理。参加高免赔额健康计划（HDHP）可能会加剧这一趋势，但性别特异性反应HDHPs尚未进行评估。我们分别测量了HDHP对男性和女性的影响。对6,007名男性和6,530名女性在雇主强制从传统健康维护组织（HMO）计划转换为HDHP计划前1年和2年内的低、中、高严重程度急诊科就诊和住院情况进行对照纵向差异分析，并与同期对照组进行比较（18，433名男性，19，178名女性）仍在HMO计划中。在过渡到HDHP后的一年中，相对于对照组，男性在所有严重程度上都大幅减少了急诊室就诊（低，中，高严重程度就诊的变化分别为-21.5%，[-37.9到-5.2]，-21.6%，[-37.4到-5.7]和-34.4%，[-62.1到-6.7]）。女性HDHP成员选择性地减少了低严重程度的急诊就诊（-26.9%，[-40.8至-13.0]），同时保留了中等和高严重程度的就诊。男性HDHP成员在第1年的住院率也相对下降了24.2% [-45.3至-3.1]，随后在第1年和第2年之间住院率相对增加了30.1% [2.1至58.1]。最初全面减少艾德和医院护理，随后增加住院治疗意味着男性可能已经放弃了HDHP过渡后所需的护理。照顾HDHPs患者的临床医生应该意识到福利设计的性别差异。
Prior studies show that men are more likely than women to defer essential care. Enrollment in high-deductible health plans (HDHP) could exacerbate this tendency, but sex-specific responses to HDHPs have not been assessed. We measured the impact of an HDHP separately for men and women. Controlled longitudinal difference-in-differences analysis of low, intermediate, and high severity emergency department visits and hospitalizations among 6,007 men and 6,530 women for 1 year before and up to 2 years after their employers mandated a switch from a traditional health maintenance organization (HMO) plan to an HDHP, compared with contemporaneous controls (18,433 men, 19,178 women) who remained in an HMO plan. In the year following transition to an HDHP, men substantially reduced emergency department visits at all severity levels relative to controls (changes in low, intermediate, and high severity visits of −21.5%, [−37.9 to −5.2], −21.6%, [−37.4 to −5.7], and −34.4%, [−62.1 to −6.7], respectively). Female HDHP members selectively reduced low severity emergency visits (−26.9%, [−40.8 to −13.0]) while preserving intermediate and high severity visits. Male HDHP members also experienced a 24.2% [−45.3 to −3.1] relative decline in hospitalizations in year 1, followed by a 30.1% [2.1 to 58.1] relative increase in hospitalizations between years 1 and 2. Initial across-the-board reductions in ED and hospital care followed by increased hospitalizations imply that men may have foregone needed care following HDHP transition. Clinicians caring for patients with HDHPs should be aware of sex differences in response to benefit design.