Child Health and Family Experience under Health Insurance Cost-Sharing

描述（由申请人提供）：Alison Galbraith，医学博士，公共卫生硕士，是一名儿科医生，致力于研究健康保险政策如何影响弱势儿童群体的健康和医疗保健。K23奖将建立在先前培训和研究的坚实基础上，并通过专家导师和顾问的多学科团队以及哈佛大学的优秀资源提供必要的先进教育和经验。在研究保健政策的重要趋势-即越来越多地采用费用分摊办法，特别是采用高免赔额保健计划的总趋势-如何影响儿童健康和保健的过程中，将获得宝贵的研究经验。近年来，健康保险计划增加了参保者的共同支付和免赔额，以应对不断上升的医疗保健费用。关于目前增加家庭分担保健费用的做法如何影响儿童的健康及其家庭的经历，现有的资料很少。拟议的研究将通过一系列补充研究，从几个角度审查儿童和家庭在HDHPs中的经验，具体目的如下：1）评估与传统计划相比，儿童和家庭水平的临床和人口统计学特征，预测HDHPs的入学率; 2）研究儿童参加HDHPs如何影响相对于传统计划的重要医疗保健服务的使用，与参加HDHPs的倾向相匹配; 3）对父母进行试点调查，从儿童家庭的角度描述HDHPs的影响，特别是未满足的医疗保健需求、经济负担和家庭医疗保健决策策略。申请人在由哈佛医学院和哈佛朝圣者医疗保健联合赞助的部门的独特环境提供了通过多种来源收集有关HDHPs和其他计划中儿童健康信息的机会，包括索赔数据和对登记者的调查。拟议的研究，课程和指导将有助于开发和应用先进的分析技术和评估儿童的医疗保健需求和结果的新技能。拟议奖项的研究和培训将使Galbraith博士成为以人口为基础的儿童健康政策研究的独立调查员，最终目标是为改善弱势儿童健康的政策提供信息。

DESCRIPTION (provided by applicant): Alison Galbraith, MD, MPH, is a pediatrician committed to a research career investigating how health insurance policies affect health and health care at the population level for vulnerable groups of children. A K23 award will build upon a strong foundation of prior training and research, and provide necessary advanced education and experience through a multidisciplinary team of expert mentors and advisors and the outstanding resources of Harvard University. Valuable research experience will be gained in the process of studying how children's health and health care are affected by important trends in health policy - namely, the general trend toward increased use of cost-sharing and specifically, the introduction of high-deductible health plans (HDHPs). In recent years, health insurance plans have increased enrollee co-payments and deductibles in response to escalating health care costs. Scant information is available on how the health of children and the experiences of their families are affected by current approaches that increase families' sharing in health care costs. The proposed research will examine the experiences of children and families in HDHPs through a complementary set of studies from several perspectives, with the following Specific Aims: 1) to evaluate the child and family-level clinical and demographic characteristics that predict enrollment in HDHPs compared to traditional plans; 2) to examine how children's enrollment in HDHPs affects use of important health care services relative to traditional plans, matching for propensity to enroll in HDHPs; and 3) to pilot a survey of parents to describe the impact of HDHPs from the perspective of the child's family, particularly on unmet health care needs, financial burden, and family health care decision making strategies. The applicant's unique environment in a department jointly sponsored by Harvard Medical School and Harvard Pilgrim Health Care provides the opportunity to collect information about the health of children in HDHPs and other plans through multiple sources, including claims data and surveys of enrollees. The proposed studies, coursework, and mentorship will help develop and apply new skills in advanced analytic techniques and assessment of children's health care needs and outcomes. The research and training of the proposed award will enable Dr. Galbraith to become an independent investigator in population-based child health policy research, with the ultimate goal of informing policy to improve the health of vulnerable children.