Family Decision Making and Burden Under High-Deductible Health Plans

描述（由申请人提供）：高免赔额健康计划（HDHPs）是美国过去十年来最重要和最具争议的发展之一。 这些计划使用每个人至少1,000美元和每个家庭2,000美元的免赔额，试图通过增加病人管理医疗保健支出的责任来控制医疗保险费用。 越来越多的成年人和儿童正在参加高免赔额的健康计划，但关于其对家庭的影响的信息很少。 这个创新项目将探讨HDHPs如何影响医疗保健使用的决策过程，包括知识，态度，降低成本的策略和感知负担。 我们将：（1）制定新的措施来描述HDHPs家庭的医疗保健决策和感知负担;（2）在对HDHPs家庭的验证调查中完善这些措施;（3）对社会经济地位低或慢性病家庭的决策模式和医疗保健使用进行探索性研究。 在目的1方面，我们会进行聚焦小组研究，以确定和改善有关医疗服务使用决策的新概念和措施。 目标2需要一个验证调查的基础上，电话采访的父母和匹配的索赔数据的医疗保健使用。 分析将评估重测信度和结构效度。 在目标3中，我们将在其他家庭中使用所得工具，并进行探索性分析，以产生进一步研究的假设。 我们将比较低社会经济地位或慢性病家庭和没有这些危险因素的家庭之间的决策模式和卫生保健使用。 例如，我们将评估教育水平较低的父母是否比其他家庭更有可能放弃预防保健。 拟议的研究是创新的，其重点是现代高免赔额安排下的家庭决策。 研究结果将有助于决策者和家庭更有效地设计和使用费用分摊安排。 它们还将为今后研究成本控制方法如何影响儿童、父母和家庭的健康创造必要的基础。

DESCRIPTION (provided by applicant): High deductible health plans (HDHPs) are one of the most important and controversial developments in U.S. health care in the past decade. Using deductibles of at least $1,000 per individual and $2,000 per family, these plans attempt to control health insurance costs by increasing patient responsibility for managing health care spending. Increasing numbers of adults and children are being enrolled in high-deductible health plans, but scant information exists about their effects on families. This innovative project will explore how HDHPs affect the processes of decision making on health care use, including knowledge, attitudes, cost-mitigating strategies, and perceived burden. We will: (1) Develop new measures to describe health care decision-making and perceived burden among families in HDHPs; (2) Refine these measures in a validation survey of families in HDHPs; and (3) Conduct an exploratory study of decision-making patterns and health care use in HDHPs by families with low socioeconomic status or chronic conditions. In Aim 1, we will conduct a focus group study to identify and refine new concepts and measures on decision-making on health care use. Aim 2 entails a validation survey based on telephone interviews with parents and matched claims data on health care use. Analyses will evaluate test-retest reliability and construct validity. In Aim 3, we will field the resulting instrument in additional families and conduct exploratory analyses to generate hypotheses for further study. We will compare decision-making patterns and health care use in HDHPs between families with low socioeconomic status or chronic conditions and families without these risk factors. For example, we will evaluate whether parents with lower educational levels are more likely to forego preventive care than other families. The proposed research is innovative in its focus on family decision-making under modern high deductible arrangements. The results will help policymakers and families improve the effective design and use of cost-sharing arrangements. They will also create essential building blocks for future studies of how cost containment approaches affect the health of children, parents, and families.