Screening for Free: A Value-Based Insurance Design Natural Experiment

免费筛选：基于价值的保险设计自然实验

基本信息

批准号：
8913062
负责人：
JOHN HSU
金额：
$ 57.42万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-05-09 至 2018-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8913062
关键词：
Advisory Committees Age-Years Breast Budgets Caring Characteristics Clinical Colonoscopy Colorectal Cost Sharing Data Diagnostic Neoplasm Staging Drug usage Economics Enrollment Event Fees Future Goals Growth Health Insurance Health Maintenance Organizations Hospitalization Incentives Individual Inpatients Insurance Insurance Benefits Laboratories Literature Malignant Neoplasms Mammography Medical Medicare National Health Policy Natural experiment Outcome Outpatients Patients Persons Pharmaceutical Preparations Physicians Police Policies Population Population Study Preferred Provider Organizations Prevention Preventive Prostate Prostate-Specific Antigen Recommendation Research Design Role Sampling Studies Screening for Prostate Cancer Screening for cancer Services Stage at Diagnosis Structure Subgroup System Testing Time Tumor stage United States Centers for Medicare and Medicaid Services Variant Visit Woman Work base beneficiary care systems colorectal cancer screening cost cost effective design financial incentive improved payment screening

项目摘要

DESCRIPTION (provided by applicant): Aligning health insurance benefits with clinical goals, aka value-based insurance design (VBID), holds much promise for reducing financial barriers to recommended care, improving quality, and modulating spending growth. While studies have found that patient cost-sharing can reduce the use of necessary care and increase spending for downstream care such as hospitalizations, there have been few rigorous VBID studies, especially of the effects on overall clinical or spending outcomes. The Patient Protection and Affordable Care Act (ACA) requires that all Medicare beneficiaries have free access to preventive services starting in 2011, thus creating a VBID natural experiment. This elimination of cost-sharing has the potential to mitigate underuse of cancer screening tests recommended by the US Preventive Services Task Force (USPSF). Using information from large Medicare Advantage plans, this project will examine the clinical and economic effects of this ACA- mandated Medicare policy change. Our 2007-2014 data contain detailed, comprehensive information on insurance benefits, individual characteristics, testing, clinical events, and medical spending. The study sample includes beneficiaries with a range of pre-policy cost-sharing amounts with the staggered elimination of cost- sharing (free screening) over time. For example, 46% of the study population had free colorectal cancer screening in 2007, 74% in 2010, and 100% in 2011; all benefit changes occur on January 1st of the year. The three aims examine the cost-sharing changes' direct and overall effects: Aim 1) screening test rates; Aim 2) clinical event rates; and Aim 3) total medical spending. We will evaluate the outcomes in all subjects and illustrative subgroups, e.g., subjects for whom screening may be of high or low value as per the USPSTF recommendations. Our primary analyses will focus on within-person changes (fixed effects estimation), and will adjust for a rich set of demographic, clinical, physician, and system characteristics. We also will compare subjects with cost-sharing versus those without cost-sharing, using as concurrent controls subjects who consistently have free screening throughout the study period. With several million person-years of data, we will have adequate power to detect even small changes in our outcomes. This study provides an opportunity to evaluate the largest VBID natural experiment to date, to examine the early effects of a major ACA provision on access to preventive care, and to inform future Medicare policy decisions.

描述（由申请人提供）：将健康保险福利与临床目标相结合，即基于价值的保险设计 (VBID)，对于减少推荐护理的财务障碍、提高质量和调节支出增长具有很大的希望。虽然研究发现患者费用分摊可以减少必要护理的使用并增加住院等下游护理的支出，但很少有严格的 VBID 研究，特别是对总体临床或支出结果的影响。《患者保护和平价医疗法案》(ACA) 要求从 2011 年开始，所有 Medicare 受益人都可以免费获得预防服务，从而创建了 VBID 自然实验。这种费用分摊的消除有可能减少美国预防服务工作组 (USPSF) 建议的癌症筛查测试的使用不足。该项目将利用大型 Medicare Advantage 计划的信息，研究 ACA 强制执行的 Medicare 政策变化的临床和经济影响。我们 2007-2014 年的数据包含有关保险福利、个人特征、测试、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保单前费用分摊金额的受益人，并随着时间的推移逐步取消费用分摊（免费筛查）。例如，2007年有46%的研究人群接受了免费结直肠癌筛查，2010年为74%，2011年为100%；所有福利变更均于当年 1 月 1 日发生。这三个目标考察了成本分摊变化的直接和总体影响：目标 1) 筛选测试率；目标 2) 临床事件发生率；目标 3) 医疗支出总额。我们将评估所有受试者和说明性亚组的结果，例如，根据 USPSTF 建议，筛选可能具有高价值或低价值的受试者。我们的主要分析将侧重于人体内的变化（固定效应估计），并将根据丰富的人口统计、临床、医生和系统特征进行调整。我们还将比较有费用分摊的受试者与没有费用分摊的受试者，使用在整个研究期间持续进行免费筛查的受试者作为同时对照受试者。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。这项研究提供了一个机会来评估迄今为止最大规模的 VBID 自然实验，检查 ACA 主要条款对获得预防性护理的早期影响，并为未来的医疗保险政策决策提供信息。