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

项目摘要/摘要 过量饮酒是导致过早死亡和残疾的第五大风险因素。健康和 与酒精使用相关的经济负担集中在约1400万有酒精使用障碍的成年人身上。 药理和行为干预，特别是当联合使用时，减少酒精的使用和相关的 损害和帮助长期恢复。然而，只有约5%的患有酒精使用障碍的成年人接受正式的 在卫生保健环境中进行治疗。最近的社会现象，即高免赔额健康的迅速崛起 计划和2019年新型冠状病毒大流行(新冠肺炎)可能导致延迟性酒精使用障碍 诊断和治疗。延期护理可能会特别影响弱势群体，如低收入人群 和农村居民。在过去的十年里，高免赔额计划要求可能令人望而却步的自掏腰包 为酒精使用障碍服务支付的费用迅速扩大，现在覆盖了57%的员工。COVID- 19大流行导致居家订单和非必要企业关闭，大幅减少 医疗保健用途。 这项提案的首要目标是研究影响酒精使用障碍的主要社会因素。 获得治疗的机会和差距，包括可修改的高免赔额健康计划和新冠肺炎 大流行。这项研究将评估酒精使用障碍相关措施在两个关键的变化日期之前和之后 利息：雇主强制要求改用高免赔额健康计划的日期(使用滚动队列 应计期)，到2020年3月新冠肺炎大流行相关限制措施开始实施。更具体地说， 该项目旨在：(1)确定高免赔额健康计划对酒精使用障碍诊断的影响， 治疗和不良后果；(2)评估高免赔额健康计划是否增加了 酒精使用障碍的诊断、治疗和不良结果；以及(3)检查酒精使用障碍的4年影响 新冠肺炎大流行关于酒精使用障碍诊断、治疗和不良后果的差异 这项研究将从2007年至2024年的18年滚动样本中抽取，调查对象为约5000万18岁成员- 通过一家全国性的健康保险公司注册。该研究将采用严格的、准实验的中断时间 采用分段回归和分段生存分析的系列设计。我们预计调查结果将 展示医疗保险福利设计，优化获得AUD治疗的机会，告知潜力 修改美国国税局条例，免除某些服务的高额自付 高免赔额计划下的成本。研究结果还有助于为大流行后的决策提供信息，因为它确定了 有延误诊断和治疗风险的亚组。

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.