Family Decision Making and Burden Under High-Deductible Health Plans

描述(由申请人提供)：高免赔额健康计划(HDHP)是过去十年来美国医疗保健领域最重要和最有争议的发展之一。这些计划使用每人至少1,000美元和每个家庭2,000美元的免赔额，试图通过增加患者管理医疗支出的责任来控制医疗保险成本。越来越多的成年人和儿童参加了高免赔额的健康计划，但关于它们对家庭的影响的信息很少。这一创新项目将探索人类发展规划如何影响卫生保健使用的决策过程，包括知识、态度、降低成本的战略和感知的负担。我们将：(1)开发新的指标来描述高风险家庭的卫生保健决策和感知负担；(2)在对高风险家庭的验证性调查中完善这些指标；(3)对低社会经济地位或慢性病家庭在高风险家庭中的决策模式和医疗保健使用进行探索性研究。在目标1中，我们将进行一项焦点小组研究，以确定和提炼关于医疗保健使用决策的新概念和新措施。AIM 2需要一项基于对父母的电话采访和匹配的医疗保健使用索赔数据的验证性调查。分析将评估重测信度和结构效度。在目标3中，我们将在更多的家庭中使用所产生的仪器，并进行探索性分析，以生成进一步研究的假设。我们将比较低社会经济地位或慢性病家庭和没有这些危险因素的家庭在高风险家庭中的决策模式和卫生保健使用。例如，我们将评估教育水平较低的父母是否比其他家庭更有可能放弃预防性护理。这项拟议的研究在关注现代高免赔额安排下的家庭决策方面具有创新性。结果将有助于政策制定者和家庭改进费用分摊安排的有效设计和使用。它们还将为未来研究成本控制方法如何影响儿童、父母和家庭的健康创造必要的基础。

DESCRIPTION (provided by applicant): High deductible health plans (HDHPs) are one of the most important and controversial developments in U.S. health care in the past decade. Using deductibles of at least $1,000 per individual and $2,000 per family, these plans attempt to control health insurance costs by increasing patient responsibility for managing health care spending. Increasing numbers of adults and children are being enrolled in high-deductible health plans, but scant information exists about their effects on families. This innovative project will explore how HDHPs affect the processes of decision making on health care use, including knowledge, attitudes, cost-mitigating strategies, and perceived burden. We will: (1) Develop new measures to describe health care decision-making and perceived burden among families in HDHPs; (2) Refine these measures in a validation survey of families in HDHPs; and (3) Conduct an exploratory study of decision-making patterns and health care use in HDHPs by families with low socioeconomic status or chronic conditions. In Aim 1, we will conduct a focus group study to identify and refine new concepts and measures on decision-making on health care use. Aim 2 entails a validation survey based on telephone interviews with parents and matched claims data on health care use. Analyses will evaluate test-retest reliability and construct validity. In Aim 3, we will field the resulting instrument in additional families and conduct exploratory analyses to generate hypotheses for further study. We will compare decision-making patterns and health care use in HDHPs between families with low socioeconomic status or chronic conditions and families without these risk factors. For example, we will evaluate whether parents with lower educational levels are more likely to forego preventive care than other families. The proposed research is innovative in its focus on family decision-making under modern high deductible arrangements. The results will help policymakers and families improve the effective design and use of cost-sharing arrangements. They will also create essential building blocks for future studies of how cost containment approaches affect the health of children, parents, and families.