High Deductible Insurance: Impact on Breast Cancer Care and Outcomes

高免赔额保险：对乳腺癌护理和结果的影响

• 批准号: 8576169
• 负责人: James Franklin Wharam
• 金额: $ 56.06万
• 依托单位: HARVARD PILGRIM HEALTH CARE, INC.
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-19 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8576169
• 关键词: Accident and Emergency department; Adherence; Adjuvant; Adopted; Affect; Age; Aromatase Inhibitors; Biopsy; Breast; Breast Cancer Detection; Cancer Diagnostics; Cancer Patient; Caring; Cause of Death; Cessation of life; Chronic Disease; Control Groups; Cost Sharing; Deductibles; Detection; Diagnostic; Diagnostic Imaging; Diagnostic tests; Disadvantaged; Disease; Disease Progression; Drug Costs; Enrollment; Excision; Expenditure; Experimental Designs; Explosion; Family; Growth; Health; Health Benefit; Health Care Costs; Health Insurance; Health Planning; Health Services Accessibility; Healthcare; Hospitalization; Incentives; Insurance; Insurance Carriers; Internal Medicine; Life; Mammography; Measures; Medical; Medicare; Minority; Modernization; Operative Surgical Procedures; Outcome; Outpatients; Patients; Pattern; Persons; Pharmaceutical Preparations; Policies; Policy Maker; Population; Procedures; Public Health; Publishing; Reporting; Research; Risk; Sample Size; Sampling; Screening for cancer; Selection Bias; Series; Services; Solutions; Statistical Methods; Survival Analysis; Testing; Time; Treatment outcome; Ultrasonography; Vulnerable Populations; Woman; Women' s Health; base; breast cancer diagnosis; cancer care; cancer diagnosis; cancer therapy; cohort; copayment; cost; design; follow-up; health savings account; hormone therapy; improved; interest; low socioeconomic status; malignant breast neoplasm; medication compliance; member; mortality; payment; prevent; primary outcome; public health relevance; research study; socioeconomics; therapy adherence; tumor; tumor progression

DESCRIPTION (provided by applicant): Breast cancer affects 12% of women during their lifetimes and is the third leading cause of death among women age 45-64. Patients being evaluated for breast cancer require a spectrum of advanced medical care including diagnostic imaging and biopsy procedures. Breast cancer patients also need access to surgical treatments and life-saving medications. A rapidly growing form of health coverage - high-deductible insurance - substantially increases patients' out-of-pocket costs for such services. Families in high-deductible health plans must pay up to $12,000 per year before more comprehensive coverage begins. Such high cost sharing levels could substantially reduce access to life-saving care, especially among underserved women such as the poor. It is essential to understand how high-deductible health plans affect breast cancer care and outcomes. Suboptimal access to care could reduce or delay detection, accelerate disease progression, and increase deaths. This proposal seeks to assess the impact of high-deductible health plans on breast cancer diagnostic testing, treatment, and outcomes in a nationally representative population. Measures of diagnostic testing will include diagnostic mammography, breast ultrasound, and breast biopsy. We also will assess changes in surgical tumor resection and adjuvant hormonal therapy use. Our primary outcome will be all-cause mortality among women screened for breast cancer. In addition, we will determine whether select high-deductible health plans with low drug cost-sharing improve outcomes compared with otherwise similar high drug cost- sharing high-deductible plans. Finally, the research will quantify the degree to which transition to high- deductible health plans affects socioeconomic disparities in these measures. This study will draw from a 15-year rolling sample of members from a large national health insurer whose employers mandated a switch from traditional to high-deductible health plans. We will use employer- and member-level propensity score matching to minimize selection bias. The study will employ strong quasi- experimental designs including interrupted time-series with comparison series and Kaplan-Meier survival curves to examine outcomes of interest. This project will be the first to examine these research questions on a national scale. Policy makers will be able to use results to design value-based insurance plans that optimize breast cancer care.

描述(申请人提供)：乳腺癌影响12%的女性一生，是45岁女性的第三大死因--。接受乳腺癌评估的患者需要一系列先进的医疗护理，包括诊断成像和活组织检查程序。乳腺癌患者还需要获得手术治疗和救命药物。一种快速增长的医疗保险形式--高免赔额保险--大大增加了患者为此类服务支付的自付费用。参加高免赔额健康计划的家庭必须每年支付高达12,000美元，然后才能开始更全面的保险。如此高的费用分担水平可能会大大减少获得挽救生命的护理的机会，特别是在穷人等服务不足的妇女中。了解高免赔额健康计划如何影响乳腺癌的护理和结果是至关重要的。获得次优护理可能会减少或推迟检测，加速疾病进展，并增加死亡。这项提案旨在评估高免赔额健康计划对全国代表性人群中乳腺癌诊断测试、治疗和结果的影响。诊断性检测的措施将包括诊断性乳房X光检查、乳房超声和乳房活检。我们还将评估外科肿瘤切除和辅助激素治疗使用的变化。我们的主要结果将是乳腺癌筛查女性的全因死亡率。此外，我们将确定，与其他类似的高药品成本分担高免赔额计划相比，我们将确定选择药品成本分担低的高免赔额健康计划是否会改善结果。最后，这项研究将量化过渡到高免赔额健康计划对这些措施中的社会经济差距的影响程度。这项研究将从一家大型全国性健康保险公司15年来滚动抽样的成员中提取出来，该公司的雇主要求从传统的健康计划转变为高免赔额的健康计划。我们将使用雇主和成员级别的倾向分数匹配，以最大限度地减少选择偏差。这项研究将采用强有力的准实验设计，包括中断的时间序列和比较序列，以及Kaplan-Meier生存曲线来检验感兴趣的结果。这个项目将是第一个在全国范围内检查这些研究问题的项目。政策制定者将能够利用结果来设计基于价值的保险计划，以优化乳腺癌的护理。