权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

High Deductible Health Plans: Substance Abuse Service Use and Cost Trajectories

高免赔额健康计划：药物滥用服务的使用和成本轨迹

基本信息

批准号：
8330816
负责人：
CYNTHIA I CAMPBELL
金额：
$ 44.26万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-09-15 至 2014-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8330816
关键词：
Abstinence Accident and Emergency department Accounting Address Alcohol abuse Alcohol or Other Drugs use Appointment Attention Behavior California Caring Characteristics Clinical Comorbidity Computerized Medical Record Cost Sharing Cost of Illness Data Deductibles Diagnosis Disease remission Drug abuse Economics Enrollment Environment Epidemiology Face Goals Health Health Care Costs Health Planning Health Services Health Services Accessibility Health Status Healthcare Improve Access Individual Information Technology Injury Insurance Intake Knowledge Legal Linear Models Medical Mental Health Modeling Monitor Motivation Online Systems Outcome Overdose Patient Education Patient Self-Report Patients Policies Population Price Primary Health Care Public Health Research Risk Sampling Services Severities Severity of illness Stigmata Substance Use Disorder Substance abuse problem Surveys System Telephone Time Treatment Cost Treatment outcome Visit care seeking cohort cost cost shifting design economic cost follow-up improved innovation medical specialties meetings member payment physical conditioning policy implication prevention service self help social stigma trend

项目摘要

DESCRIPTION (provided by applicant): This application, "High deductible health plans: substance abuse service use and cost trajectories," responds to PA-08-174: Economics of Treatment and Prevention Services for Drug & Alcohol Abuse (R01). We propose to examine the impact of high deductible health plans (HDHP) on utilization, costs, and outcomes of patients with substance use (SU) problems over time. We have a unique opportunity to study these questions as Kaiser Permanente Northern California (KPNC) is currently implementing HDHPs. We first examine selection effects in patient characteristics of SU intakes with (and without) the HDHPs across five years (2006-2010) using clinical and administrative health plan data and the electronic medical record (EMR). We then examine 3-year trends in utilization of SU treatment services, medical services, and health care costs by HDHP status for a sample of members who had an intake to SU treatment between 01/2006 and 06/2007 (n=16,313). Finally, we conduct a telephone survey of a cohort of SU treatment intakes from 2009 (n=400) to examine patient knowledge of the HDHP benefits, SU outcomes, and care-seeking behavior in the face of high cost-sharing. This research addresses a key scientific and policy issue: utilization and cost and outcomes of SU treatment in a health care environment that has increasingly turned to HDHP products to control costs by shifting costs to patients. Demand for SU treatment is seen as more price-sensitive than medical care and SU benefits are more limited with higher cost-sharing. This can potentially delay treatment seeking, with increased disease severity and costs over time. The SU population has unique characteristics, including high comorbidities, that may raise the patient risk profile under HDHPs. These individuals often have unanticipated costs such as emergency room visits due to injuries or overdoses. The study is innovative in its use of information technology, including the EMR to examine study questions, and for its clinical implications. Access to the health plan's web-based Outcomes Monitoring System provides baseline epidemiologic information on SU at intake to treatment, enabling a follow-up outcomes survey. We use propensity score analyses to model selection effects and hierarchical linear models for longitudinal analyses. HDHPs are increasingly available and findings have important policy implications outside of KPNC. Findings may improve access to SU treatment, outcomes, reduce costs, and improve patient education and activation. Policy implications include changing benefit designs to include SU treatment as a high value health care service, with low co-payments, or embedding SU treatment services in primary care.

描述（由申请人提供）：本申请，“高免赔额健康计划：药物滥用服务的使用和成本轨迹”，回应PA-08-174：药物和酒精滥用治疗和预防服务的经济学（R 01）。我们建议检查高免赔额的健康计划（HDHP）的利用率，成本和结果的患者物质使用（SU）的问题，随着时间的推移的影响。我们有一个独特的机会来研究这些问题，因为凯撒永久北方加州（KPNC）目前正在实施HDHPs。我们首先研究选择效果的患者特征的SU摄入量（和没有）HDHPs在五年（2006-2010年）使用临床和行政健康计划数据和电子病历（EMR）。然后，我们研究了3年的趋势，利用SU治疗服务，医疗服务，和卫生保健费用的HDHP状态的成员谁有摄入量SU治疗之间的01/2006年和06/2007年（n=16,313）的样本。最后，我们对2009年开始接受SU治疗的队列（n=400）进行了电话调查，以检查患者对HDHP益处的了解、SU结局以及面对高费用分担时的就医行为。这项研究解决了一个关键的科学和政策问题：在越来越多地转向HDHP产品的医疗保健环境中，SU治疗的利用率、成本和结果通过将成本转移给患者来控制成本。对SU治疗的需求被视为比医疗保健更敏感的价格和SU的好处是有限的更高的成本分摊。这可能会延迟寻求治疗，随着时间的推移，疾病的严重程度和成本会增加。SU人群具有独特的特征，包括高合并症，这可能会增加HDHP下的患者风险特征。这些人往往有意外的费用，如急诊室访问由于受伤或过量。该研究在信息技术的使用方面具有创新性，包括EMR检查研究问题及其临床意义。访问健康计划的基于网络的结果监测系统提供了基线流行病学信息的SU在摄入治疗，使后续结果调查。我们使用倾向得分分析模型的选择效果和分层线性模型的纵向分析。越来越多的人可以获得HDHPs，调查结果在KPNC之外具有重要的政策影响。这些发现可能会改善SU治疗的可及性、结局、降低成本，并改善患者教育和激活。政策影响包括改变福利设计，包括SU治疗作为一个高价值的医疗保健服务，低共同支付，或嵌入SU治疗服务在初级保健。