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Impact of high deductible health plans and COVID-19 on alcohol use disorder treatment access, outcomes, and disparities

高免赔额健康计划和 COVID-19 对酒精使用障碍治疗可及性、结果和差异的影响

基本信息

批准号：
10706546
负责人：
James Franklin Wharam
金额：
$ 68.73万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-20 至 2026-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10706546
关键词：
2019-nCoV Acceleration Accident and Emergency department Adoption Adult Adverse event Affect Affordable Care Act Alcohol consumption Alcoholic Intoxication Alcohols American Behavior Therapy Bipolar Disorder Businesses COVID-19 COVID-19 pandemic COVID-19 pandemic effects Caring Cessation of life Cohort Studies Data Deductibles Diabetes Mellitus Diagnosis Disparity Disparity population Economic Burden Economics Emergency Situation Enrollment Ethnic Origin Family Financial Hardship Funding Goals Health Health Insurance Health Services Accessibility Healthcare Insurance Insurance Benefits Insurance Carriers Interruption Low income Marketing Measures Modification Outcome Outcome Study Persons Pharmaceutical Preparations Pharmacological Treatment Policy Making Population Poverty Privatization Quasi-experiment Race Readiness Regulation Reporting Research Design Resources Risk Risk Factors Sampling Series Services Societal Factors Statutes and Laws Subgroup Substance Use Disorder Survival Analysis Time Treatment Cost Treatment outcome United States adverse outcome aged alcohol availability alcohol risk alcohol use disorder barrier to care behavioral health cohort comparison group coronavirus pandemic cost data infrastructure design diagnostic criteria disability ethnic minority population experience health care settings health plan health savings account high risk improved interest long term recovery malignant breast neoplasm member outcome disparities pandemic impact parity payment pharmacologic post-pandemic pre-pandemic premature racial minority population reduced alcohol use rehabilitation service rural dwellers rurality social stay-at-home order treatment disparity trend

项目摘要

PROJECT SUMMARY/ABSTRACT Excessive alcohol use is the 5th-leading risk factor for premature death and disability. The health and economic burden associated with alcohol use is concentrated in ~14 million adults with alcohol use disorder. Pharmacological and behavioral interventions, especially when combined, reduce alcohol use and related harms and assist long-term recovery. However, only ~5% adults with alcohol use disorder receive formal treatment in health care settings. Recent societal phenomena, namely the rapid rise of high-deductible health plans and the 2019 novel coronavirus pandemic (COVID-19), might contribute to delayed alcohol use disorder diagnosis and treatment. Deferred care might especially affect disadvantaged populations such as low-income and rural residents. In the last decade, high-deductible plans requiring potentially prohibitive out-of-pocket payments for alcohol use disorder services have expanded rapidly, now covering 57% of workers. The COVID- 19 pandemic led to stay-at-home orders and closure of nonessential businesses, dramatically reducing healthcare use. The overarching goal of this proposal is to examine major societal factors affecting alcohol use disorder treatment access and disparities, including modifiable high-deductible health plans and the COVID-19 pandemic. The study will assess alcohol use disorder-related measures before and after 2 key change dates of interest: the date that employers mandate a switch to high-deductible health plans (using a rolling cohort accrual period), and March 2020 when COVID-19 pandemic-related restrictions began. More specifically, the project seeks to: (1) determine the effect of high-deductible health plans on alcohol use disorder diagnosis, treatment, and adverse outcomes; (2) assess whether high-deductible health plans increase disparities in alcohol use disorder diagnosis, treatment, and adverse outcomes; and (3) examine the 4-year impact of the COVID-19 pandemic on disparities in alcohol use disorder diagnosis, treatment, and adverse outcomes The study will draw from an 18-year rolling sample (2007-2024) of ~50 million members aged 18-64 enrolled through a national health insurer. The study will apply rigorous, quasi-experimental interrupted time series designs with segmented regression and segmented survival analyses. We expect that findings will demonstrate the health insurance benefit designs that optimize access to AUD treatment, informing potential modifications to Internal Revenue Service regulations that exempt certain services from high out-of-pocket costs under high-deductible plans. Findings could also help inform post-pandemic policymaking by identifying subgroups at risk of delayed diagnosis and treatment.

项目总结/文摘