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

描述(申请人提供)：当糖尿病患者的血糖水平得到控制并仔细监测他们的疾病时，他们可以享受更长和更健康的生命。长期以来，专家们一直主张更好地遵守降血糖药物和二级预防措施，特别是针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。参加高免赔额健康计划的家庭必须在更全面的保险开始之前，每年自付最高4000美元。参加这些计划的人数正在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。降低护理水平可能会导致疾病加速发展和糖尿病相关死亡。这项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果的影响。二级预防措施将包括血红蛋白A1C检测、血脂检测和视网膜检查。结果将包括高度严重的急诊科就诊、可预防的住院和住院天数。这项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，这项研究将确定在完全分担药品成本的情况下和不完全分担药品成本的情况下，高免赔额健康计划对服药依从性和结果的影响。这项研究将从一家大型全国性健康保险公司12年的滚动成员样本中提取，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。雇主和成员层面的倾向分数匹配将被用来创建一个同时进行的控制组，其选择效果最小。这项研究将采用强有力的准实验前置设计和对照组设计来检验我们感兴趣的结果。这将是第一次在全国范围内检查这些研究问题的研究，也是第一次使用创新的成员级方法来检测高危人群。研究结果应有助于政策制定者、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.