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High Deductible Insurance: Impact on Breast Cancer Care and Outcomes

高免赔额保险：对乳腺癌护理和结果的影响

基本信息

批准号：
9324899
负责人：
James Franklin Wharam
金额：
$ 57.3万
依托单位：
HARVARD PILGRIM HEALTH CARE, INC.
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-19 至 2019-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9324899
关键词：
Adherence Adjuvant Adopted Affect Affordable Care Act Age Aromatase Inhibitors Biopsy Breast Breast Cancer Detection Breast Cancer Patient Breast biopsy Caring Cause of Death Cessation of life Chronic Disease Control Groups Cost Sharing Deductibles Detection Diagnostic Diagnostic Imaging Diagnostic tests Disadvantaged Disease Disease Progression Drug Costs Eligibility Determination Emergency department visit Enrollment Excision Expenditure Experimental Designs Explosion Family Growth Health Health Benefit Health Care Costs Health Insurance Health Planning Health Services Accessibility Healthcare Hospitalization Incentives Insurance Insurance Carriers Internal Medicine Interruption Life Mammography Measures Medical Medicare Modernization Operative Surgical Procedures Outcome Outpatients Patients Pattern Persons Pharmaceutical Preparations Policies Policy Maker Population Privatization Procedures Public Health Publishing Reporting Research Risk Sample Size Sampling Savings Screening for cancer Selection Bias Series Services Statistical Methods Survival Analysis Testing Time Treatment outcome Ultrasonography Vulnerable Populations Woman Women&apos s Health base breast cancer diagnosis cancer care cancer diagnosis cancer therapy cohort copayment cost design experimental study follow-up health savings account hormone therapy improved improved outcome interest low socioeconomic status malignant breast neoplasm medication compliance member mortality payment prevent primary outcome public health relevance racial minority socioeconomic disparity therapy adherence tumor tumor progression

项目摘要

DESCRIPTION (provided by applicant): Breast cancer affects 12% of women during their lifetimes and is the third leading cause of death among women age 45-64. Patients being evaluated for breast cancer require a spectrum of advanced medical care including diagnostic imaging and biopsy procedures. Breast cancer patients also need access to surgical treatments and life-saving medications. A rapidly growing form of health coverage - high-deductible insurance - substantially increases patients' out-of-pocket costs for such services. Families in high-deductible health plans must pay up to $12,000 per year before more comprehensive coverage begins. Such high cost sharing levels could substantially reduce access to life-saving care, especially among underserved women such as the poor. It is essential to understand how high-deductible health plans affect breast cancer care and outcomes. Suboptimal access to care could reduce or delay detection, accelerate disease progression, and increase deaths. This proposal seeks to assess the impact of high-deductible health plans on breast cancer diagnostic testing, treatment, and outcomes in a nationally representative population. Measures of diagnostic testing will include diagnostic mammography, breast ultrasound, and breast biopsy. We also will assess changes in surgical tumor resection and adjuvant hormonal therapy use. Our primary outcome will be all-cause mortality among women screened for breast cancer. In addition, we will determine whether select high-deductible health plans with low drug cost-sharing improve outcomes compared with otherwise similar high drug cost- sharing high-deductible plans. Finally, the research will quantify the degree to which transition to high- deductible health plans affects socioeconomic disparities in these measures. This study will draw from a 15-year rolling sample of members from a large national health insurer whose employers mandated a switch from traditional to high-deductible health plans. We will use employer- and member-level propensity score matching to minimize selection bias. The study will employ strong quasi- experimental designs including interrupted time-series with comparison series and Kaplan-Meier survival curves to examine outcomes of interest. This project will be the first to examine these research questions on a national scale. Policy makers will be able to use results to design value-based insurance plans that optimize breast cancer care.

描述（由申请人提供）：乳腺癌影响12%的妇女在其一生中，是第三大死亡原因的妇女年龄45-64。接受乳腺癌评估的患者需要一系列先进的医疗护理，包括诊断成像和活检程序。乳腺癌患者还需要获得手术治疗和挽救生命的药物。一种快速增长的医疗保险形式--高免赔额保险--大大增加了患者对此类服务的自付费用。高免赔额健康计划的家庭必须每年支付高达12,000美元，才能开始更全面的覆盖。如此高的费用分摊水平可能会大大减少获得救生护理的机会，特别是在穷人等得不到充分服务的妇女中。了解高免赔额健康计划如何影响乳腺癌护理和结果至关重要。次优的医疗服务可能会减少或延迟检测，加速疾病进展，并增加死亡人数。该提案旨在评估高免赔额健康计划对全国代表性人群中乳腺癌诊断检测，治疗和结果的影响。诊断测试的措施将包括诊断性乳房X光检查、乳房超声和乳房活检。我们还将评估手术肿瘤切除和辅助激素治疗使用的变化。我们的主要结果将是接受乳腺癌筛查的妇女的全因死亡率。此外，我们还将确定与其他类似的高药物费用分摊高免赔额计划相比，选择低药物费用分摊高免赔额健康计划是否能改善结局。最后，该研究将量化过渡到高免赔额健康计划在多大程度上影响这些措施中的社会经济差异。这项研究将从一家大型国家健康保险公司的成员中抽取15年的滚动样本，这些保险公司的雇主要求从传统的健康计划转向高免赔额的健康计划。我们将使用雇主和成员级别的倾向得分匹配，以尽量减少选择偏差。本研究将采用强准实验设计，包括中断时间序列与比较序列和Kaplan-Meier生存曲线，以检查关注的结局。该项目将是第一个在全国范围内审查这些研究问题的项目。政策制定者将能够利用这些结果来设计基于价值的保险计划，以优化乳腺癌护理。

项目成果

期刊论文数量（8）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Impact of high-deductible insurance on adjuvant hormonal therapy use in breast cancer.

DOI：
10.1007/s10549-018-4821-z
发表时间：
2018-08
期刊：
Breast cancer research and treatment
影响因子：
3.8
作者：
Lu CY;Zhang F;Wagner AK;Nekhlyudov L;Earle CC;Callahan M;LeCates R;Xu X;Ross-Degnan D;Wharam JF
通讯作者：
Wharam JF

Erratum to: Racial disparities in all-cause mortality among younger commercially insured women with incident metastatic breast cancer.

勘误表：患有转移性乳腺癌的年轻商业保险女性全因死亡率的种族差异。

DOI：
10.1007/s10549-016-3988-4
发表时间：
2016
期刊：
Breast cancer research and treatment
影响因子：
3.8
作者：
Leopold,Christine;Wagner,AnitaK;Zhang,Fang;Lu,ChristineY;Earle,Craig;Nekhlyudov,Larissa;Ross-Degnan,Dennis;Wharam,JFrank
通讯作者：
Wharam,JFrank

Out-of-Pocket Costs and Outpatient Visits Among Patients With Cancer in High-Deductible Health Plans.

高免赔额健康计划中癌症患者的自付费用和门诊就诊。

DOI：
10.1001/jamaoncol.2023.6052
发表时间：
2024
期刊：
JAMA oncology
影响因子：
28.4
作者：
Trad,NicolasK;Zhang,Fang;Wharam,JamesFranklin
通讯作者：
Wharam,JamesFranklin

Total and out-of-pocket expenditures among women with metastatic breast cancer in low-deductible versus high-deductible health plans.

DOI：
10.1007/s10549-018-4819-6
发表时间：
2018-09
期刊：
Breast cancer research and treatment
影响因子：
3.8
作者：
Leopold C;Wagner AK;Zhang F;Lu CY;Earle CC;Nekhlyudov L;Ross-Degnan D;Wharam JF
通讯作者：
Wharam JF