Natural Experiment of Value-Based Incentives for Preventive Services

基于价值的预防服务激励的自然实验

• 批准号: 8384231
• 负责人: JOHN HSU
• 金额: $ 70.96万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-24 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8384231
• 关键词: 2 year old; Adolescent; Advisory Committees; Affect; Age; American; Behavior; Budgets; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Chickenpox; Child; Clinical; Cost Sharing; Data; Data Set; Databases; Disease; Dose; Economics; Effectiveness; Enrollment; Event; Face; Future; Goals; Group Health Insurance; Health Insurance; Healthcare; Human Papillomavirus; Immunization; Improve Access; Incentives; Individual; Inpatients; Insurance; Insurance Benefits; Link; Literature; Long-Term Effects; Medical; Meningococcal vaccine; National Health Policy; Natural experiment; Office Visits; Only Child; Outcome; Outpatients; Patients; Persons; Pertussis; Pharmaceutical Preparations; Police; Policies; Population; Prevention; Preventive; Price; Role; Rotavirus; Sampling; Sampling Studies; Sentinel; Series; Services; System; Testing; Time; Vaccines; Variant; Visit; Work; base; care systems; comparative; cost; design; disorder prevention; financial incentive; improved; member; models and simulation; novel vaccines; prevent; tool

DESCRIPTION (provided by applicant): Financial incentives can be powerful tools to influence health care behavior. The literature suggests that patients faced with high levels of cost-sharing have lower use of preventive services than patients with less cost-sharing, but there are few studies in children and only a limited number of studies in any population demonstrating that the elimination of cost-sharing increases use of prevention. This alignment of insurance benefit design with clinical goals, aka value-based insurance design (VBID), is a central feature of the recent Patient Protection and Affordable Care Act (ACA). The ACA requires that all health insurance plans eliminate cost-sharing for high value preventive services including those services recommended by the US Preventive Services Task Force (USPSTF) and the Centers for Disease Control and Prevention (CDC) as of 2011; the ACA, however, exempts existing employer-sponsored (i.e., group) insurance plans from these policies provided that the plans do not make major changes in their benefits or prices. Thus, individuals within these "grandfathered" plans continue to face the same cost-sharing for preventive care. We will exploit this natural experiment to examine how the elimination of cost-sharing for annual wellness visits and immunizations affects children and adolescents (age up to 21 years). Individuals enrolled in group health insurance plans without cost-sharing changes and tests not recommended by the USPSTF provide concurrent comparative information. Using data from the MarketScan Databases and from Kaiser Permanente, the project will examine the early clinical and economic effects of this ACA-mandated health insurance policy change on our outcomes: Aim 1) office visit rates; Aim 2) immunizations; and Aim 3) total medical spending. Our data contain detailed, comprehensive information on insurance benefits, individual characteristics, immunizations, clinical events, and medical spending. The study sample includes subjects with a range of baseline cost-sharing amounts and in the timing of cost-sharing changes. Our primary analyses will focus on within-person changes (fixed effects estimation), and will adjust for a rich set of demographic, clinical, and system characteristics. With several million person-years of data, we will have adequate power to detect even small changes in our outcomes. PUBLIC HEALTH RELEVANCE: This study will examine the effects of providing free wellness visits and immunizations to children and adolescents enrolled in group health insurance plans. The recent Patient Protection and Affordable Care Act requires that group insurance plans eliminate cost-sharing for these types of preventive services, but exempts many existing plans from the new rules. In other words, there are over one hundred million Americans for whom the ACA rules concerning preventive services do not apply because they are enrolled in existing group health insurance plans with "grandfather" status. Moreover, although providing free preventive services for children and adolescents is intuitively appealing, it is unclear whether th elimination of cost-sharing will improve access to preventive services, increase immunization rates, or affect overall medical spending. This work will inform national health policy decisions and ongoing efforts to improve the quality and efficiency of care.

描述（由申请人提供）：经济激励可以成为影响医疗保健行为的有力工具。文献表明，与费用分摊较少的患者相比，面临高水平费用分摊的患者对预防服务的使用较少，但针对儿童的研究很少，而且在任何人群中的研究数量也有限，表明消除费用- 共享增加预防的使用。这种保险福利设计与临床目标的结合，又称为基于价值的保险设计 (VBID)，是最近《患者保护和平价医疗法案》(ACA) 的核心特征。 ACA 要求所有健康保险计划取消高价值预防服务的费用分摊，包括美国预防服务工作组 (USPSTF) 和疾病控制与预防中心 (CDC) 自 2011 年起推荐的服务；然而，如果现有的雇主赞助（即团体）保险计划的福利或价格没有发生重大变化，《平价医疗法案》将其排除在这些保单之外。因此，这些“祖父”计划中的个人继续面临相同的预防性护理费用分摊。我们将利用这一自然实验来研究取消每年健康检查和免疫接种费用分摊对儿童和青少年（21 岁以下）的影响。加入团体健康保险计划但未进行费用分摊变更的个人以及 USPSTF 未推荐的测试可提供同时的比较信息。该项目将利用 MarketScan 数据库和 Kaiser Permanente 的数据，研究 ACA 规定的健康保险政策变更对我们结果的早期临床和经济影响：目标 1) 办公室就诊率；目标2）免疫接种；目标 3) 医疗支出总额。我们的数据包含有关保险福利、个人特征、免疫接种、临床事件和医疗支出的详细、全面的信息。研究样本包括具有一系列基线成本分摊金额和成本分摊变化时间的受试者。我们的主要分析将侧重于人体内的变化（固定效应估计），并将针对丰富的人口统计、临床和系统特征进行调整。有了数百万人年的数据，我们将有足够的能力来检测结果的微小变化。 公共卫生相关性：本研究将探讨为参加团体健康保险计划的儿童和青少年提供免费健康就诊和免疫接种的效果。最近的《患者保护和平价医疗法案》要求团体保险计划取消此类预防性服务的费用分摊，但使许多现有计划免受新规则的约束。换句话说，有超过一亿美国人因以“祖父”身份参加了现有的团体健康保险计划，因此不适用 ACA 有关预防服务的规定。此外，尽管为儿童和青少年提供免费预防服务直观上很有吸引力，但尚不清楚取消费用分摊是否会改善获得预防服务的机会、提高免疫率或影响总体医疗支出。这项工作将为国家卫生政策决策和提高护理质量和效率的持续努力提供信息。