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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)：本申请名为“高免赔额健康计划：药物滥用服务使用和成本轨迹”，响应PA-08-174：药物和酒精滥用治疗和预防服务的经济学(R01)。我们建议检查高免赔额健康计划(HDHP)随着时间的推移对药物使用(SU)问题患者的利用率、成本和结果的影响。我们有一个独特的机会来研究这些问题，因为凯撒永久北加州(KPNC)目前正在实施HDHPS。我们首先使用临床和行政健康计划数据和电子病历(EMR)，在五年(2006-2010年)中检验了使用和不使用HDHPS的SU摄入量的患者特征中的选择效应。然后，我们考察了2006年1月1日至2007年6月6日期间接受SU治疗的成员(n=16,313)，按HDHP状态对SU治疗服务、医疗服务和卫生保健费用的利用的三年趋势。最后，我们对2009年(n=400)接受SU治疗的队列进行了电话调查，以检查患者对HDHP益处、SU结果的了解，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产品以通过将成本转嫁给患者来控制成本的医疗环境中，SU治疗的利用率、成本和结果。与医疗相比，对SU治疗的需求被认为对价格更敏感，SU的好处更有限，成本分担更高。这可能会推迟寻求治疗，随着时间的推移，疾病的严重性和成本会增加。SU人群具有独特的特征，包括高共存性，这可能会增加HDHPS下的患者风险。这些人往往有意想不到的费用，如因受伤或过量服药而去急诊室就诊。这项研究在使用信息技术，包括电子病历来检查研究问题及其临床意义方面具有创新性。访问健康计划的基于网络的结果监测系统可提供从接受到治疗的SU的基线流行病学信息，从而能够进行后续结果调查。我们使用倾向分数分析来分析模型的选择效果，并使用分层线性模型来进行纵向分析。人类发展方案越来越多地可用，研究结果对KPNC以外的国家具有重要的政策影响。这些发现可能会改善SU治疗的机会、结果、降低成本，并改善患者的教育和激活。政策影响包括改变福利设计，将SU治疗作为一种高价值的医疗服务，自付费用较低，或将SU治疗服务嵌入初级保健。