Optimizing Choice of Health Insurance For Diabetes (OrCHID)

项目摘要 糖尿病影响着10%的美国人口，每年造成2370亿美元的直接医疗费用。 初级保健和专家访问，药物和测试用品，耐用的医疗设备，实验室测试， 并且潜在的紧急情况和医院访问可能是昂贵的。糖尿病患者报告说， 相对于非糖尿病患者的负担，努力支付必要的医疗保健，食物，住房， 退休与费用相关的不依从性（延迟配药或减少服药）， 糖尿病发病率高，因此，医疗保险计划中的患者所需服务的覆盖率低， 和资源经历不良后果，如高血糖或低血糖，急性脑血管疾病， 缺血性心脏病由于延迟或放弃护理。因此，选择一个健康保险计划，满足 您的需求对改善健康至关重要，特别是对于低收入社会经济地位的患者。 不幸的是，许多消费者很难从提供的众多健康计划中选择一个， 单一因素，如成本，使用逻辑学来做出决定，受到挑战理性的偏见的影响， 决策理论，以及未能权衡计划功能之间的权衡。 我们假设，健康经济陈述偏好方法，如离散选择实验和多， 标准决策分析可用于引出健康计划偏好和价值。这些工具特别要求 患者可以权衡多个计划功能之间的权衡，并可以评估哪些功能会影响患者 决定最多。在这项观察性自然实验研究中，我们将使用陈述偏好调查， 系统地评估患者对充分涵盖糖尿病护理的健康计划的偏好。我们将 利用我们对来自哈佛朝圣者医疗保健和塔夫茨健康的健康计划和索赔数据的访问 计划，两个新英格兰的保险公司，共220万覆盖的生命。我们将分析 患者偏好与其现实世界健康计划之间的一致性。最后，我们将评估 偏好一致的健康计划登记与不良糖尿病健康结果、成本 相关治疗不依从性、接受适当的高质量糖尿病护理、医疗保健费用和 利用率、患者经济负担和计划满意度。如果与偏好一致的健康计划与 更好的健康和医疗保健结果，未来的工作将开发一种决策辅助工具，使患者能够澄清 他们对卫生保健的价值观和偏好，并选择一个计划，使他们能够使用预防保健 减少不良健康事件并减轻他们的经济负担。如果没有，未来的研究可以使用研究 结果来设计一种决策辅助工具，该决策辅助工具将消费者引导到具有与改善的健康相关联的特征的计划， 医疗保健利用率、医疗保健成本和消费者满意度。

PROJECT ABSTRACT Diabetes affects 10% of the U.S. population and is responsible for $237 billion in direct medical costs annually. Primary care and specialist visits, medications and testing supplies, durable medical equipment, lab testing, and potential emergency and hospital visits can be costly. Patients with diabetes report a high level of financial burden relative to patients without diabetes, struggling to pay for necessary health care, food, housing, and retirement. Cost-related non-adherence (delaying filling a prescription or taking less medicine) for patients with diabetes is high, and subsequently, patients in health insurance plans with poor coverage for needed services and resources experience adverse outcomes like hyper- or hypoglycemia, acute cerebrovascular disease, and ischemic heart disease due to delayed or forgone care. Therefore, choosing a health insurance plan that meets your needs is critical to improve health, especially for patients with low income socioeconomic status. Unfortunately, many consumers struggle to choose a health plan from among the many offered, focusing on a single factor like costs, using heuristics to make decisions, falling subject to biases that challenge rational decision-making theory, and failing to weigh trade-offs between plan features. We hypothesize that health economic stated preference methods like discrete choice experiments and multi- criteria decision analyses can be used to elicit health plan preferences and values. These tools specifically ask patients to weigh trade-offs between multiple plan features and can assess which features influence patient decisions the most. In this observational natural experiment study, we will use stated preference surveys to systematically assess patient preferences for health plans that adequately cover diabetes care. We will leverage our access to health plan and claims data from Harvard Pilgrim Health Care and the Tufts Health Plan, two New England-based insurers with a combined 2.2 million covered lives. We will analyze the concordance between patient preferences and their real-world health plan. Finally, we will assess the relationship between preference-aligned health plan enrollment and adverse diabetes health outcomes, cost- related treatment non-adherence, receipt of appropriate high-quality diabetes care, health care costs and utilization, patient financial burden, and plan satisfaction. If preference-aligned health plans are associated with better health and health care outcomes, future work will develop a decision aid that allows patients to clarify their values and preferences for health care and choose a plan that will enable them to use preventive care that reduces adverse health events and lowers their financial burden. If not, future research can use study results to design a decision aid that directs consumers to plans with features associated with improved health, health care utilization, health care costs, and consumer satisfaction.