High Deductible Health Plans and Receipt of Recommended Medical Care

在过去的5年里，参加高免赔额健康计划(HDHP)的人数增加了50%，超过 45%的私人保险美国人参加了这样的计划。HDHPS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)自掏腰包，直到达到(高)免赔额。 为慢性病管理提供的服务受这一免赔额的约束。因此，目前还不清楚 这种保险形式是否支持健康老龄化，特别是对七成50岁的美国人--(安 NIA优先人群)患有慢性病。较高的患者费用分担导致这两种药物的使用减少 必要和不必要的医疗保健。然而，目前尚不清楚医疗保健使用量的减少是否意味着 患者没有得到管理其慢性病所需的医疗保健类型。 这项研究的总体目标是确定高成本分担设计的HDHPS是否会导致 慢性病患者没有得到循证的、高质量的治疗建议 其次，他们的设计中内置的成本障碍是否会导致更差的健康结果 HDHP加入者。我们还估计了接受高质量护理所需的患者支出 HDHP与非HDHP的比较，并调查任何基于种族、性别或收入的护理差异 HDHP患者所经历的。我们的HDHP调查重点是那些患有一种或多种 以下常见慢性病：糖尿病、冠状动脉疾病、心力衰竭、哮喘、高血压或 严重的抑郁症。最后，我们使用在新冠肺炎大流行期间实施的临时福利设计更改 作为一种外源性冲击，以了解HDHPS对接受推荐医疗服务的影响。 以前，人类发展计划的研究没有集中于对最需要服务的人群的影响(即 慢性疾病)和人类发展规划对差异的影响。我们评估，在很大程度上 有较高医疗保健需求的中年成年人，这种共同福利设计是否会导致较低的 护理(由于患者自付费用较高)和不利的健康后果。 这项工作的结果与政策相关。调查结果可以为有关慢性病豁免的规定提供参考 从保险免赔额中进行疾病管理，并确定支持基于价值的保险的最佳方式 设计。为了确保研究结果到达决策者手中，我们将通过兰德研究简报传播研究结果 致保险购买者、保险公司、国家保险部门的领导和 除了向科学界传播的传统机制外，大会还提供了一种新的传播机制。

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.