Individuals Eligible for Lung Cancer Screening Less Likely to Receive Screening When Enrolled in Health Plans With Deductibles.
Individuals Eligible for Lung Cancer Screening Less Likely to Receive Screening When Enrolled in Health Plans With Deductibles.
复制标题
有资格进行肺癌筛查的个人在加入具有免赔额的健康计划时接受筛查的可能性较小。
DOI：
10.1097/mlr.0000000000001903
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发表时间：
2023
期刊：
影响因子：
3
通讯作者：
Ritzwoller,DebraP
中科院分区：
文献类型：
--
作者：
Wain,Kris;Carroll,NikkiM;Honda,Stacey;Oshiro,Caryn;Ritzwoller,DebraP
背景：2015 年，医疗保险和医疗补助服务中心以及商业保险计划开始承保肺癌筛查 (LCS)，而无需为所有计划分摊患者费用。尽管没有自付费用要求，我们还是探讨了加入免赔额计划对 LCS 服务使用的影响。方法：这项回顾性研究分析了来自基于人群的研究以优化肺脏筛查过程联盟的数据。我们的队列包括在 2015 年 2 月 5 日至 2019 年 2 月 28 日期间加入管理式医疗组织的非 Medicare LCS 资格个人。我们估计了一系列序贯逻辑回归模型，检查基线 LCS 所需事件序列的利用率。我们报告了加入自付额计划与加入无自付额计划相比的边际效应。结果：加入自付额计划的总体影响是基线 LCS 降低了 1.8 个百分点 (PP)。分别探索每个转变的序贯逻辑回归结果表明，免赔额计划注册与临床医生就诊减少 4.3 PP、LCS 订单减少 1.7 PP 以及基线 LCS 减少 7.0 PP 相关。所有可观察到的种族和民族都持续减少。结论：这些发现表明，参加免赔额计划的个人更有可能放弃预防性 LCS 服务，尽管不需要自付费用。这一结果可能表明，增加的成本分摊与放弃推荐的濒海战斗舰的次优选择相关。或者，这种效应可能表明参加免赔额计划的个人更喜欢减少医疗保健的使用。健康计划层面的患者外展干预可能会改善 LCS。
Background:In 2015, the Centers for Medicare & Medicaid Services and commercial insurance plans began covering lung cancer screening (LCS) without patient cost-sharing for all plans. We explore the impact of enrolling into a deductible plan on the utilization of LCS services despite having no out-of-pocket cost requirement.Methods:This retrospective study analyzed data from the Population-based Research to Optimize the Screening Process Lung Consortium. Our cohort included non-Medicare LCS-eligible individuals enrolled in managed care organizations between February 5, 2015, and February 28, 2019. We estimate a series of sequential logistic regression models examining utilization across the sequence of events required for baseline LCS. We report the marginal effects of enrollment into deductible plans compared with enrollment in no-deductible plans.Results:The total effect of deductible plan enrollment was a 1.8 percentage-point (PP) decrease in baseline LCS. Sequential logistic regression results that explore each transition separately indicate deductible plan enrollment was associated with a 4.3 PP decrease in receipt of clinician visit, a 1.7 PP decrease in receipt of LCS order, and a 7.0 PP decrease in receipt of baseline LCS. Reductions persisted across all observable races and ethnicities.Conclusions:These findings suggest individuals enrolled in deductible plans are more likely to forgo preventive LCS services despite requiring no out-of-pocket costs. This result may indicate that increased cost-sharing is associated with suboptimal choices to forgo recommended LCS. Alternatively, this effect may indicate individuals enrolling into deductible plans prefer less health care utilization. Patient outreach interventions at the health plan level may improve LCS.