Impact of high deductible health plans and COVID-19 on alcohol use disorder treatment access, outcomes, and disparities

高免赔额健康计划和 COVID-19 对酒精使用障碍治疗可及性、结果和差异的影响

• 批准号: 10372511
• 负责人: James Franklin Wharam
• 金额: $ 73.88万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-20 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10372511
• 关键词: 2019-nCoV; Acceleration; Accident and Emergency department; Adoption; Adult; Adverse event; Affect; Affordable Care Act; Alcohol consumption; Alcoholic Intoxication; Alcohols; American; Behavior Therapy; Bipolar Disorder; Businesses; COVID-19; COVID-19 pandemic; COVID-19 pandemic effects; Caring; Cessation of life; Cohort Studies; Data; Deductibles; Diabetes Mellitus; Diagnosis; Economic Burden; Economics; Emergency Situation; Enrollment; Ethnic Origin; Family; Financial Hardship; Funding; Goals; Health; Health Insurance; Health Services Accessibility; Healthcare; Home; Insurance; Insurance Benefits; Insurance Carriers; Interruption; Low income; Measures; Modification; Outcome; Outcome Study; Persons; Pharmaceutical Preparations; Pharmacological Treatment; Pharmacology; Population; Poverty; Privatization; Race; Readiness; Recovery; Regulation; Reporting; Research Design; Resources; Risk; Risk Factors; Sampling; Series; Services; Societal Factors; Statutes and Laws; Subgroup; Substance Use Disorder; Survival Analysis; Time; Treatment Cost; Treatment outcome; United States; adverse outcome; aged; alcohol availability; alcohol risk; alcohol use disorder; barrier to care; behavioral health; cohort; comparison group; cost; data infrastructure; design; diagnostic criteria; disability; disadvantaged population; ethnic minority population; experience; health care settings; health economics; health plan; health savings account; high risk; improved; interest; malignant breast neoplasm; member; pandemic coronavirus; pandemic disease; parity; payment; premature; racial and ethnic; reduced alcohol use; rehabilitation service; rural dwellers; rurality; social; treatment disparity; trend

PROJECT SUMMARY/ABSTRACT Excessive alcohol use is the 5th-leading risk factor for premature death and disability. The health and economic burden associated with alcohol use is concentrated in ~14 million adults with alcohol use disorder. Pharmacological and behavioral interventions, especially when combined, reduce alcohol use and related harms and assist long-term recovery. However, only ~5% adults with alcohol use disorder receive formal treatment in health care settings. Recent societal phenomena, namely the rapid rise of high-deductible health plans and the 2019 novel coronavirus pandemic (COVID-19), might contribute to delayed alcohol use disorder diagnosis and treatment. Deferred care might especially affect disadvantaged populations such as low-income and rural residents. In the last decade, high-deductible plans requiring potentially prohibitive out-of-pocket payments for alcohol use disorder services have expanded rapidly, now covering 57% of workers. The COVID- 19 pandemic led to stay-at-home orders and closure of nonessential businesses, dramatically reducing healthcare use. The overarching goal of this proposal is to examine major societal factors affecting alcohol use disorder treatment access and disparities, including modifiable high-deductible health plans and the COVID-19 pandemic. The study will assess alcohol use disorder-related measures before and after 2 key change dates of interest: the date that employers mandate a switch to high-deductible health plans (using a rolling cohort accrual period), and March 2020 when COVID-19 pandemic-related restrictions began. More specifically, the project seeks to: (1) determine the effect of high-deductible health plans on alcohol use disorder diagnosis, treatment, and adverse outcomes; (2) assess whether high-deductible health plans increase disparities in alcohol use disorder diagnosis, treatment, and adverse outcomes; and (3) examine the 4-year impact of the COVID-19 pandemic on disparities in alcohol use disorder diagnosis, treatment, and adverse outcomes The study will draw from an 18-year rolling sample (2007-2024) of ~50 million members aged 18-64 enrolled through a national health insurer. The study will apply rigorous, quasi-experimental interrupted time series designs with segmented regression and segmented survival analyses. We expect that findings will demonstrate the health insurance benefit designs that optimize access to AUD treatment, informing potential modifications to Internal Revenue Service regulations that exempt certain services from high out-of-pocket costs under high-deductible plans. Findings could also help inform post-pandemic policymaking by identifying subgroups at risk of delayed diagnosis and treatment.

项目摘要/摘要 过度使用酒精是过早死亡和残疾的第五个领先危险因素。健康和 与酒精使用相关的经济负担集中在约1400万饮酒障碍的成年人中。 药理和行为干预措施，尤其是合并后，减少酒精饮酒和相关 危害并有助于长期康复。但是，只有约5％的成年人患有饮酒障碍的成年人接受正式 在医疗保健环境中的治疗。最近的社会现象，即高脱离健康的迅速增长 计划和2019年新型冠状病毒大流行（Covid-19）可能导致延迟的酒精使用障碍 诊断和治疗。延期护理可能特别影响弱势群体，例如低收入 和农村居民。在过去的十年中，高脱扣计划需要潜在的自付费用 酒精使用障碍服务的付款迅速扩大，现在覆盖了57％的工人。共同 19大流行导致了全家订单和非必要企业的关闭，大大降低了 医疗保健使用。 该提案的总体目标是检查影响酒精使用障碍的主要社会因素 治疗访问和差异，包括可修改的高扣除健康计划和COVID-19 大流行。该研究将在2个关键变更日期之前和之后评估与酒精使用障碍有关的措施 兴趣：雇主要求切换到高额健康计划的日期（使用滚动队列 应计时期），并于2020年3月1920年3月19日开始了与大流行有关的限制。更具体地说，是 项目寻求：（1）确定高脱离卫生计划对酒精使用障碍诊断的影响， 治疗和不良结果； （2）评估高脱扣健康计划是否增加了差距 酒精使用障碍诊断，治疗和不良结果； （3）检查了4年的影响 COVID-19关于酒精使用障碍诊断，治疗和不良结果的差异的大流行 这项研究将从约5000万成员的18-64名成员中汲取18年的滚动样本（2007-2024） 通过国家健康保险公司参加。该研究将应用严格的准实验中断时间 通过分段回归和分段生存分析的串联设计。我们希望发现会 演示优化获得AUD治疗的健康保险福利设计，并告知潜力 修改国内税收服务法规，以免除某些服务免于高昂的自付费用 在高扣除计划下的费用。调查结果还可以通过识别来帮助备注后的政策制定 有延迟诊断和治疗风险的亚组。