High Deductible Insurance: Impact on Breast Cancer Care and Outcomes

描述（由申请人提供）：乳腺癌在其一生中影响12%的妇女，是45-64岁妇女死亡的第三大原因。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救命药物。一种快速增长的医疗保险形式——高免赔额保险——大大增加了病人为这类服务支付的自付费用。参加高免赔额医疗计划的家庭必须每年支付高达12,000美元，才能开始更全面的保险。如此高的费用分摊水平可能会大大减少获得拯救生命的护理的机会，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是至关重要的。获得护理的次优机会可能减少或延迟发现，加速疾病进展，并增加死亡。本提案旨在评估高免赔额健康计划对全国代表性人群乳腺癌诊断检测、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、乳房超声检查和乳房活检。我们还将评估手术肿瘤切除和辅助激素治疗使用的变化。我们的主要结局是接受乳腺癌筛查的妇女的全因死亡率。此外，我们将确定选择低药物费用分担的高免赔额健康计划是否与其他类似的高药物费用分担高免赔额计划相比改善了结果。最后，研究将量化过渡到高免赔额健康计划对这些措施中社会经济差异的影响程度。这项研究将从一家大型国家健康保险公司的15年滚动样本中抽取成员，该公司的雇主要求他们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水平的倾向得分匹配来最小化选择偏差。该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，以检查感兴趣的结果。这个项目将是第一个在全国范围内研究这些研究问题的项目。决策者将能够使用结果来设计基于价值的保险计划，以优化乳腺癌护理。

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.