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: 8549291
• 负责人: JOHN HSU
• 金额: $ 64.46万
• 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/8549291
• 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.

描述（由申请人提供）：经济激励措施可以是影响医疗保健行为的强大工具。文献表明，面对高成本分担的患者的预防服务使用较低的患者的使用较少，但在儿童中的研究很少，并且在任何人群中只有有限的研究表明，消除成本分布会增加预防的使用。保险福利设计与临床目标（又称基于价值的保险设计（VBID））的一致性是最近的《患者保护和负担得起的护理法》（ACA）的核心特征。 ACA要求所有健康保险计划都消除了高价值预防服务的成本分布，包括美国预防服务工作组（USPSTF）和截至2011年疾病控制与预防中心（CDC）推荐的服务；但是，ACA将现有的雇主赞助（即集团）保险计划免除这些保单，但规划没有对其福利或价格进行重大更改。因此，这些“祖父”计划中的个人继续面临预防保健的相同成本分布。我们将利用这项自然实验，以研究消除年度健康访问和免疫接种的成本分布如何影响儿童和青少年（年龄长达21岁）。参加团体健康保险计划的个人而没有成本分布的变化和USPSTF建议的测试提供并发的比较信息。使用MarketScan数据库和Kaiser Permanente的数据，该项目将研究此ACA规定的健康保险政策对我们结果的早期临床和经济影响：AIM 1）办公室访问率；目标2）免疫；目标3）总医疗支出。我们的数据包含有关保险福利，个人特征，免疫，临床事件和医疗支出的详细全面信息。研究样本包括具有一系列基线成本分布量的受试者，以及成本分担变化的时间。我们的主要分析将集中于人身变化（固定效果估计），并将适应丰富的人口，临床和系统特征。有了数百万人年的数据，我们将有足够的能力来检测我们的成果的微小变化。