The Impact of Emerging Health Insurance Designs on Diabetes Outcomes and Disparit

描述（由申请人提供）：糖尿病患者在血糖水平得到控制和病情得到仔细监测的情况下，寿命更长，更健康。长期以来，专家们一直主张提高对降糖药物和二级预防措施的依从性，特别是对少数民族和穷人等服务不足的人群。然而，一种新型的健康保险——高免赔额健康计划——可能会威胁到患者获得关键医疗服务的机会。参加高免赔额医疗计划的家庭必须每年支付高达4000美元的自掏腰包，才能开始更全面的保险。参加这些计划的人数正以前所未有的速度增长。了解高免赔额健康计划如何影响糖尿病人群和服务不足患者的二级预防和结果是至关重要的。降低护理水平可能导致疾病加速进展和糖尿病相关死亡。本提案旨在评估高免赔额健康计划对糖尿病二级预防和全国代表性糖尿病人群结局的影响。二级预防措施包括糖化血红蛋白检测、血脂检测和视网膜检查。结果将包括严重的急诊科就诊、可预防的住院和住院天数。该研究还将量化过渡到高免赔额健康计划对糖尿病二级预防和结果的社会经济和种族/民族差异的影响程度。最后，该研究将确定高免赔额健康计划对药物依从性和结果的影响。这项研究将从一家大型国家健康保险公司的成员中抽取12年的滚动样本，该公司的雇主要求他们从传统的健康计划转向高免赔额的健康计划。雇主水平和成员水平倾向得分匹配将用于创建一个具有最小选择效应的并发对照组。该研究将采用强有力的准实验前后比较组设计来检查我们感兴趣的结果。这将是第一个在全国范围内检查这些研究问题的研究，也是第一个使用创新的成员级方法来检测高危人群的研究。研究结果将有助于决策者、患者和医生了解糖尿病患者的最佳健康计划福利设计。

DESCRIPTION (provided by applicant): Patients with diabetes enjoy longer and healthier lives when their blood glucose levels are controlled and their disease is monitored carefully. Experts have long advocated for improved adherence to hypoglycemic medications and secondary prevention measures, especially for underserved populations such as ethnic minorities and the poor. However, a new type of health insurance - high-deductible health plans - may threaten patients' access to crucial medical care. Families in high-deductible health plans must pay up to $4000 per year out-of-pocket before more comprehensive coverage begins. Enrollment in these plans is growing at unprecedented rates. It is essential to understand how high-deductible health plans affect secondary prevention and outcomes among populations with diabetes and in underserved patients. Reduced levels of care could lead to accelerated disease progression and diabetes-related deaths. This proposal seeks to assess the impact of high-deductible health plans on diabetes secondary prevention and outcomes in a nationally representative diabetic population. Measures of secondary prevention will include hemoglobin A1C testing, lipid testing, and retina exams. Outcomes will include high severity emergency department visits, preventable hospitalizations, and hospitalization days. The study will also quantify the degree to which transition to a high-deductible health plan affects socioeconomic and racial/ethnic disparities in diabetes secondary prevention and outcomes. Finally, the study will determine impact of high-deductible health plans with and without full drug cost-sharing on medication adherence and outcomes. This study will draw from a 12-year rolling sample of members from a large national health insurer whose employers mandated a switch from traditional to high-deductible health plans. Employer- and member-level propensity score matching will be used to create a concurrent control group with minimal selection effects. The study will employ a strong quasi-experimental pre-post with comparison group design to examine our outcomes of interest. This will be the first study to examine these research questions on a national scale and the first to use an innovative member-level method for detecting at-risk populations. Results should help inform policy makers, patients, and physicians regarding optimal health plan benefit designs for patients with diabetes.