High Deductible Insurance: Impact on Breast Cancer Care and Outcomes

高免赔额保险：对乳腺癌护理和结果的影响

基本信息

批准号：
8576169
负责人：
James Franklin Wharam
金额：
$ 56.06万
依托单位：
HARVARD PILGRIM HEALTH CARE, INC.
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-19 至 2018-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8576169
关键词：
Accident and Emergency department Adherence Adjuvant Adopted Affect Age Aromatase Inhibitors Biopsy Breast Breast Cancer Detection Cancer Diagnostics Cancer Patient Caring Cause of Death Cessation of life Chronic Disease Control Groups Cost Sharing Deductibles Detection Diagnostic Diagnostic Imaging Diagnostic tests Disadvantaged Disease Disease Progression Drug Costs Enrollment Excision Expenditure Experimental Designs Explosion Family Growth Health Health Benefit Health Care Costs Health Insurance Health Planning Health Services Accessibility Healthcare Hospitalization Incentives Insurance Insurance Carriers Internal Medicine Life Mammography Measures Medical Medicare Minority Modernization Operative Surgical Procedures Outcome Outpatients Patients Pattern Persons Pharmaceutical Preparations Policies Policy Maker Population Procedures Public Health Publishing Reporting Research Risk Sample Size Sampling Screening for cancer Selection Bias Series Services Solutions Statistical Methods Survival Analysis Testing Time Treatment outcome Ultrasonography Vulnerable Populations Woman Women&apos s Health base breast cancer diagnosis cancer care cancer diagnosis cancer therapy cohort copayment cost design follow-up health savings account hormone therapy improved interest low socioeconomic status malignant breast neoplasm medication compliance member mortality payment prevent primary outcome public health relevance research study socioeconomics therapy adherence tumor tumor progression

项目摘要

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.

描述（由申请人提供）：乳腺癌影响 12% 的女性一生，是 45-64 岁女性的第三大死因。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生药物。快速增长的健康保险形式——高免赔额保险——大大增加了患者接受此类服务的自付费用。在开始更全面的承保之前，参加高免赔额健康计划的家庭每年必须支付最多 12,000 美元。如此高的费用分摊水平可能会大大减少获得救生护理的机会，特别是对于穷人等服务不足的妇女而言。了解高免赔额健康计划如何影响乳腺癌护理和结果至关重要。获得医疗服务的机会不佳可能会减少或延迟检测、加速疾病进展并增加死亡人数。该提案旨在评估高免赔额健康计划对全国代表性人群中乳腺癌诊断检测、治疗和结果的影响。诊断测试的措施包括诊断性乳房X线照相术、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。我们的主要结果是接受乳腺癌筛查的女性的全因死亡率。此外，我们将确定与其他类似的高药物费用分摊高免赔额计划相比，选择具有低药物费用分摊的高免赔额健康计划是否可以改善结果。最后，该研究将量化向高免赔额健康计划的过渡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医疗保险公司的会员中抽取 15 年的滚动样本，该保险公司的雇主强制要求从传统医疗计划转向高免赔额医疗计划。我们将使用雇主和会员级别的倾向评分匹配来最大程度地减少选择偏差。该研究将采用强大的准实验设计，包括带有比较序列的中断时间序列和卡普兰-迈耶生存曲线来检查感兴趣的结果。该项目将是第一个在全国范围内研究这些研究问题的项目。政策制定者将能够利用结果来设计基于价值的保险计划，以优化乳腺癌护理。