High Deductible Health Plans and Receipt of Recommended Medical Care

在过去5年中，高免赔额健康计划（HDHPs）的注册人数增加了50%， 45%的私人保险美国人参加了这类计划。HDHPs要求患者支付100%的费用， 大多数保健（不包括一些初级或二级预防保健）自掏腰包，直到达到（高）免赔额。 为慢性病管理提供的服务受此免赔额的限制。因此， 这种形式的保险是否支持健康的老龄化，特别是对于70%的50-64岁的美国人（ NIA优先人群）。高患者费用分摊导致两者的使用减少 必要和不必要的医疗保健。然而，目前尚不清楚医疗保健使用的减少是否意味着 患者没有得到管理其慢性病所需的医疗保健类型。 这项研究的首要目标是确定高成本分摊设计是否会导致 慢性病患者没有接受基于证据的高质量护理， 其次，他们的设计中的成本障碍是否会导致更差的健康结果， HDHP入组者。我们还估计了在2010年接受高质量护理所需的患者支出的规模。 HDHPs与非HDHPs，并调查任何基于种族、性别或收入的护理差异 HDHP患者的经验。我们将HDHP研究的重点放在患有一种或多种 以下常见慢性疾病：糖尿病、冠状动脉疾病、心力衰竭、哮喘、高血压，或 重度抑郁症最后，我们采用在COVID-19疫情期间实施的临时福利设计变更 作为一种外源性休克，以了解HDHPs对接受推荐的医疗护理的影响。 以前的HDHP研究并没有集中在对最需要服务的人群的影响上（即，那些 慢性病患者）和高健康水平的人对不平等的影响。我们评估，对于大部分的 中年人有很高的医疗保健需求，这种共同的利益设计是否会导致较低的利用率， 护理（由于患者自付费用高）和不良健康结果。 这项工作的结果与政策有关。调查结果可以为关于慢性病豁免的法规提供信息 疾病管理从保险免赔额，并确定最佳方式，以支持基于价值的保险 设计为确保决策者了解研究结果，我们将通过兰德研究简报传播研究结果 对保险购买者、保险公司领导、国家保险部门和 除了传统的向科学界传播信息的机制外，大会还提供信息。

Enrollment in high deductible health plans (HDHPs) has increased 50% in the past 5 years, with more than 45% of privately-insured Americans enrolled in such plans. HDHPs require patients to pay 100% of the costs of most care (excluding some primary or secondary preventive care) out of pocket until a (high) deductible is met. Services provided for chronic disease management are subject to this deductible. Therefore, it is unclear whether this form of insurance supports healthy aging, especially for the 70% of Americans aged 50-64 (an NIA priority population) with chronic illness. High patient cost-sharing has caused decreases in use of both necessary and unnecessary health care. However, it is not known whether reductions in healthcare use mean that patients are not receiving the types of healthcare required to manage their chronic diseases. The overarching goal of this study is to ascertain whether the high cost-sharing design of HDHPs results in chronically-ill patients not receiving the evidence-based, high-quality care recommended for management their illnesses and secondarily, whether the cost barriers built into their design result in poorer health outcomes for HDHP enrollees. We also estimate the magnitude of patient spending required to receive high quality care in HDHPs versus non-HDHPs and investigate any race-, gender-, or income-based disparities in care experienced by HDHP patients. We focus our HDHP investigations on patients who have one or more of the following common chronic illnesses: diabetes, coronary artery disease, heart failure, asthma, hypertension, or major depression. Lastly, we use a temporary benefit design change enacted during the COVID-19 pandemic as an exogenous shock to understand the impact of HDHPs on receipt of recommended medical care. Previously HDHP research has not focused on impacts on populations most in need of services (i.e., those with chronic conditions) and the impact of HDHPs on disparities. We evaluate, for the substantial proportion of mid-life adults with high healthcare needs, whether this common benefit design results in lower utilization of care (due to high patient out-of-pocket costs) and adverse health outcomes. Results from this work are policy-relevant. Findings can inform regulations regarding the exemption of chronic disease management from insurance deductibles and identify the best way to support value-based insurance design. To ensure findings reach decision makers, we will disseminate results through RAND Research Briefs to insurance purchasers, leaders at insurance companies, state departments of insurance, and members of Congress, in addition to traditional mechanisms of dissemination to the scientific community.