Incentive Formularies and the Costs and Quality of Care

激励性处方集以及护理成本和质量

• 批准号: 6965825
• 负责人: Bruce E. Landon
• 金额: $ 28万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-30 至 2007-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6965825
• 关键词: behavioral /social science research tag; clinical research; consumer product; cost effectiveness; decision making; drug /agent; health care cost /financing; health care policy; health care quality; health care service evaluation; health care service utilization; health insurance; health services research tag; human data; managed care; pharmacology; pharmacy administration; public health

DESCRIPTION (provided by the applicant): After a period of relative stability in the mid-1990s, medical costs are again rising at double-digit rates. Pharmaceutical spending is responsible for a large proportion of this growth. Employers and health insurers have pursued multiple strategies to control increasing pharmaceutical costs, including the use of "incentive formularies" that promote the use of more cost efficient agents by consumers of care through the use of tiered levels of copayments. The rise of incentive formularies is part of a broader trend in health care whose goal is to shift more of the financial burden of medical decision making onto consumers of care. This proposal takes advantage of a comprehensive current data set derived from a unique relationship that we have established with a large national health plan that will give us access to data on 1.25 million people under the age of 65 who were continuously enrolled in the health plan for the two-year period of January 2000-December 2001, when incentive formularies started to become popular. We will use these data to examine the consequences of shifting decisions about pharmaceutical agents and the associated economic burden to beneficiaries. In particular, we will study variation in both pharmaceutical and total medical spending and in quality of care associated with changes in cost sharing for drugs. We propose to use two different and complementary approaches. The first design will be a pre/post intervention with a concurrent control group (differences-in-differences). The second approach will utilize a regression format to estimate the effects on spending and quality of care implied by the pharmacy benefit designs. The regression approach will allow us to estimate effects of a wide variety of benefit designs. The enrollees are clustered in a smaller set of markets where the health plan has a large presence. This clustering will allow us to include substantial numbers of employers (and enrollees) in the same market that have stable benefit structures as well as others that have changed their benefit structure thereby controlling for local market effects.

描述（由申请人提供）：经过 20 世纪 90 年代中期的相对稳定时期后，医疗费用再次以两位数的速度上涨。医药支出占这一增长的很大一部分。雇主和健康保险公司采取了多种策略来控制不断增加的药品成本，包括使用“激励处方集”，通过使用分级的共付额，促进护理消费者使用更具成本效益的药物。激励性处方集的兴起是医疗保健领域更广泛趋势的一部分，其目标是将更多医疗决策的经济负担转移给医疗消费者。该提案利用了一个全面的当前数据集，该数据集源自我们与一项大型国家卫生计划建立的独特关系，这将使我们能够访问 125 万名 65 岁以下的人的数据，这些人连续参加了该卫生计划2000 年 1 月至 2001 年 12 月的两年期间，激励处方开始流行。我们将利用这些数据来研究改变药剂决策的后果以及给受益人带来的相关经济负担。特别是，我们将研究药品和总医疗支出以及与药物成本分摊变化相关的护理质量的变化。我们建议使用两种不同且互补的方法。第一个设计将是同时对照组的前/后干预（双重差异）。第二种方法将利用回归格式来估计药房福利设计对支出和护理质量的影响。回归方法将使我们能够估计各种福利设计的效果。参保者集中在较小的市场中，健康计划在这些市场中占有很大份额。这种集群将使我们能够在同一市场中纳入大量具有稳定福利结构的雇主（和参与者），以及其他已经改变其福利结构的雇主（和参与者），从而控制当地市场的影响。