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，“高扣除健康计划：滥用药物的使用和成本轨迹”，对PA-08-174回应：药物和酒精滥用的治疗和预防服务经济学（R01）。我们建议检查高扣除额健康计划（HDHP）对随着时间的使用（SU）问题的利用，成本和结果的影响。我们有一个独特的机会研究这些问题，因为Kaiser Permanente North California（KPNC）目前正在实施HDHP。我们首先使用临床和行政健康计划数据以及电子病历（EMR）检查了（且没有）HDHP的SU摄入量的患者特征的选择效果。然后，我们研究了HDHP状态的SU治疗服务，医疗服务和医疗保健费用的3年趋势，用于在01/2006至06/2007之间摄入SU治疗的样本（n = 16,313）。最后，我们对2009年的SU治疗摄入量（n = 400）进行了电话调查，以检查患者对HDHP益处，SU成果和寻求护理行为的了解，面对高成本分担。这项研究解决了一个关键的科学和政策问题：在医疗保健环境中的利用，成本和SU治疗的成本和结果，在医疗保健环境中，越来越多地转向HDHP产品来通过转移患者的成本来控制成本。 SU治疗的需求比医疗保健更敏感，而SU的收益更加有限，而成本分布更高。随着疾病的严重程度和成本随着时间的流逝，这可能会延迟寻求治疗。 SU人群具有独特的特征，包括高合并症，可能会在HDHP下提高患者风险。这些人经常有意外的费用，例如由于受伤或服药过量而导致的急诊室就诊。这项研究在使用信息技术方面具有创新性，包括EMR检查研究问题及其临床意义。访问健康计划的基于Web的结果监控系统提供了有关SU摄入治疗时SU的基线流行病学信息，从而实现了后续结果调查。我们使用倾向得分分析来模拟选择效应和分层线性模型，以进行纵向分析。 HDHP越来越多，发现在KPNC之外具有重要的政策影响。调查结果可能会改善获得SU治疗，结果，降低成本并改善患者教育和激活的机会。政策的影响包括更改福利设计以包括SU治疗作为高价值医疗服务，以低的共付款或将SU治疗服务嵌入初级保健中。