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

基本信息

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
项目类别：
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

项目摘要

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.

项目概要/摘要过量饮酒是过早死亡和残疾的第五大危险因素。健康和与饮酒相关的经济负担集中在约 1400 万患有酒精使用障碍的成年人身上。药理学和行为干预，特别是结合起来，可以减少饮酒和相关的饮酒伤害并有助于长期恢复。然而，只有约 5% 的患有酒精使用障碍的成年人接受过正规治疗在医疗保健机构中进行治疗。最近的社会现象，即高免赔额健康迅速崛起计划和 2019 年新型冠状病毒大流行 (COVID-19) 可能会导致延迟性酒精使用障碍诊断和治疗。延期护理可能尤其影响弱势群体，例如低收入群体和农村居民。在过去的十年中，高免赔额计划可能需要自付费用，但可能令人望而却步酒精使用障碍服务的支付范围迅速扩大，目前已覆盖 57% 的工人。新冠病毒—— 19大流行导致居家令和非必要企业关闭，大幅减少医疗保健用途。该提案的总体目标是研究影响酒精使用障碍的主要社会因素治疗的可及性和差异，包括可修改的高免赔额健康计划和 COVID-19 大流行。该研究将评估酒精使用障碍相关措施在 2 个关键变化日期之前和之后的情况。利息：雇主强制转换为高免赔额健康计划的日期（使用滚动队列）应计期），以及 2020 年 3 月开始实施与 COVID-19 大流行相关的限制。更具体地说，项目旨在：(1) 确定高免赔额健康计划对酒精使用障碍诊断的影响，治疗和不良后果； (2) 评估高免赔额健康计划是否会增加收入差距酒精使用障碍的诊断、治疗和不良后果； (3) 检查 4 年的影响 COVID-19 大流行对酒精使用障碍诊断、治疗和不良结果的差异造成影响该研究将从 18 年的滚动样本（2007 年至 2024 年）中抽取约 5000 万年龄在 18 岁至 64 岁之间的会员通过国民健康保险公司加入。该研究将采用严格的、准实验的中断时间具有分段回归和分段生存分析的系列设计。我们预计调查结果将展示可优化 AUD 治疗机会的健康保险福利设计，告知潜力修改国税局法规，免除某些服务的高额自付费用高免赔额计划下的费用。研究结果还可以通过确定存在延迟诊断和治疗风险的亚组。