High Deductible Health Plans and Receipt of Recommended Medical Care

高免赔额健康计划和推荐医疗护理收据

• 批准号: 10364509
• 负责人: Risha Gidwani Marszowski
• 金额: $ 79.73万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-15 至 2025-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10364509
• 关键词: Address; Adult; Adverse event; Affect; Age; Ambulatory Care; American; Asthma; COVID-19 pandemic; Caring; Cessation of life; Chronic; Chronic Disease; Chronically Ill; Clinical Practice Guideline; Communities; Congresses; Coronary Arteriosclerosis; Cost Sharing; Data; Deductibles; Diabetes Mellitus; Disease; Disease Management; Eligibility Determination; Enrollment; Ensure; Evaluation; Family; Gatekeeping; Gender; Goals; Guidelines; Health; Health Care Costs; Healthcare; Heart failure; Hypertension; Income; Individual; Insurance; Insurance Carriers; Investigation; Literature; Major Depressive Disorder; Measures; Medical; Medicare; Modeling; National Institute on Aging; Outcome; Outpatients; Patients; Performance; Pharmaceutical Preparations; Policies; Population; Prevention Research; Preventive care; Process; Quality of Care; Quasi-experiment; Race; Regulation; Research; Services; Shock; Testing; Visit; Vulnerable Populations; Work; acute care; aged; base; burden of illness; care costs; care seeking; cost; cost shifting; design; evidence base; experience; health care availability; health care disparity; health care quality; health plan; healthy aging; insurance plan; medically necessary care; member; middle age; novel; pandemic disease; premature; prevent; racial disparity; response; secondary analysis; sex; shift work; telehealth; waiver

Enrollment in high deductible health plans (HDHPs) has increased 50% in the past 5 years, with more than 45% of privately-insured Americans enrolled in such plans. HDHPs require patients to pay 100% of the costs of most care (excluding some primary or secondary preventive care) out of pocket until a (high) deductible is met. Services provided for chronic disease management are subject to this deductible. Therefore, it is unclear whether this form of insurance supports healthy aging, especially for the 70% of Americans aged 50-64 (an NIA priority population) with chronic illness. High patient cost-sharing has caused decreases in use of both necessary and unnecessary health care. However, it is not known whether reductions in healthcare use mean that patients are not receiving the types of healthcare required to manage their chronic diseases. The overarching goal of this study is to ascertain whether the high cost-sharing design of HDHPs results in chronically-ill patients not receiving the evidence-based, high-quality care recommended for management their illnesses and secondarily, whether the cost barriers built into their design result in poorer health outcomes for HDHP enrollees. We also estimate the magnitude of patient spending required to receive high quality care in HDHPs versus non-HDHPs and investigate any race-, gender-, or income-based disparities in care experienced by HDHP patients. We focus our HDHP investigations on patients who have one or more of the following common chronic illnesses: diabetes, coronary artery disease, heart failure, asthma, hypertension, or major depression. Lastly, we use a temporary benefit design change enacted during the COVID-19 pandemic as an exogenous shock to understand the impact of HDHPs on receipt of recommended medical care. Previously HDHP research has not focused on impacts on populations most in need of services (i.e., those with chronic conditions) and the impact of HDHPs on disparities. We evaluate, for the substantial proportion of mid-life adults with high healthcare needs, whether this common benefit design results in lower utilization of care (due to high patient out-of-pocket costs) and adverse health outcomes. Results from this work are policy-relevant. Findings can inform regulations regarding the exemption of chronic disease management from insurance deductibles and identify the best way to support value-based insurance design. To ensure findings reach decision makers, we will disseminate results through RAND Research Briefs to insurance purchasers, leaders at insurance companies, state departments of insurance, and members of Congress, in addition to traditional mechanisms of dissemination to the scientific community.

过去 5 年，高免赔额健康计划 (HDHP) 的注册人数增加了 50%，超过 45% 的私人保险美国人参加了此类计划。 HDHP 要求患者支付 100% 的费用 大多数护理（不包括一些初级或二级预防护理）都是自掏腰包，直到达到（高）免赔额。 为慢性病管理提供的服务须缴纳此免赔额。因此，尚不清楚 这种形式的保险是否支持健康老龄化，特别是对于 70% 的 50-64 岁美国人（ NIA 优先人群）患有慢性疾病。高昂的患者费用分摊导致两者的使用减少 必要和不必要的医疗保健。然而，尚不清楚医疗保健使用的减少是否意味着 患者没有接受治疗慢性病所需的医疗保健类型。 本研究的总体目标是确定 HDHP 的高成本分摊设计是否会导致 慢性病患者没有接受治疗建议的循证高质量护理 其次，其设计中的成本障碍是否会导致健康状况较差 HDHP 注册者。我们还估计了患者在以下地区接受高质量护理所需的支出规模： HDHP 与非 HDHP 的比较，并调查护理方面任何基于种族、性别或收入的差异 HDHP 患者经历过。我们的 HDHP 调查重点针对患有一种或多种以下疾病的患者： 以下常见慢性疾病：糖尿病、冠状动脉疾病、心力衰竭、哮喘、高血压或 严重抑郁症。最后，我们使用了 COVID-19 大流行期间制定的临时福利设计变更 作为外源性冲击，以了解 HDHP 对接受推荐的医疗护理的影响。 此前，HDHP 研究并未关注对最需要服务的人群（即那些 慢性病）以及 HDHP 对差异的影响。我们评估，对于很大一部分 具有高医疗保健需求的中年成年人，这种共同的福利设计是否会导致较低的利用率 护理（由于患者自付费用较高）和不良健康结果。 这项工作的结果与政策相关。研究结果可以为有关慢性病豁免的法规提供信息 从保险免赔额进行疾病管理，并确定支持基于价值的保险的最佳方式 设计。为了确保决策者能够了解研究结果，我们将通过兰德研究简报传播结果 致保险购买者、保险公司领导、国家保险部门和会员 大会，除了传统的向科学界传播的机制。