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

项目总结/摘要 过度饮酒是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1400万患有酒精使用障碍的成年人身上。 药物和行为干预，特别是当结合使用时，可以减少酒精使用和相关的 并帮助长期恢复。然而，只有约5%的酒精使用障碍成年人接受正式的 在卫生保健机构进行治疗。最近的社会现象，即高免赔额的健康 计划和2019年新型冠状病毒大流行（COVID-19），可能会导致延迟性酒精使用障碍 诊断和治疗。延迟护理可能特别影响低收入等弱势群体， 和农村居民。在过去的十年里，高免赔额的计划，需要潜在的禁止自付 酒精使用障碍服务的支付迅速扩大，现在覆盖了57%的工人。COVID- 19大流行导致居家订单和非必要业务关闭， 保健用途。 该提案的总体目标是研究影响酒精使用障碍的主要社会因素 治疗机会和差距，包括可修改的高免赔额健康计划和COVID-19 流行病这项研究将评估酒精使用障碍相关的措施之前和之后的2个关键变化日期， 利息：雇主强制转换为高免赔额健康计划的日期（使用滚动队列 2019冠状病毒病疫情相关限制措施开始生效。更具体而言是 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）评估高免赔额的健康计划是否会增加 酒精使用障碍的诊断、治疗和不良结局;（3）检查酒精使用障碍的4年影响。 COVID-19大流行对酒精使用障碍诊断、治疗和不良结局的差异 这项研究将从18年（2007-2024年）的滚动样本中抽取约5000万18-64岁的成员 通过国家健康保险公司注册。这项研究将采用严格的、准实验性的中断时间 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 展示健康保险福利设计，优化获得AUD治疗，告知潜在的 修改国内税收署的规定，免除某些服务的高自付 高免赔额计划下的费用。研究结果还可以通过确定 有延迟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.