High Deductible Health Plans: Substance Abuse Service Use and Cost Trajectories

高免赔额健康计划：药物滥用服务的使用和成本轨迹

基本信息

批准号：
8023874
负责人：
CYNTHIA I CAMPBELL
金额：
$ 47.18万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-09-15 至 2013-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8023874
关键词：
Abstinence Accident and Emergency department Accounting Address Alcohol abuse Alcohol or Other Drugs use Appointment Attention Behavior California Caring Characteristics Clinical Comorbidity Computerized Medical Record Cost Sharing Cost of Illness Data Deductibles Diagnosis Disease remission Drug abuse Economics Enrollment Environment Epidemiology Face Goals Health Health Care Costs Health Planning Health Services Health Services Accessibility Health Status Healthcare Improve Access Individual Information Technology Injury Insurance Intake Knowledge Legal Linear Models Medical Mental Health Modeling Monitor Motivation Online Systems Outcome Overdose Patient Education Patient Self-Report Patients Policies Population Price Primary Health Care Public Health Research Risk Sampling Services Severities Severity of illness Stigmata Substance Use Disorder Substance abuse problem Surveys System Telephone Time Treatment Cost Treatment outcome Visit care seeking cohort cost cost shifting design economic cost follow-up improved innovation medical specialties meetings member payment physical conditioning policy implication prevention service self help social stigma trend

项目摘要

DESCRIPTION (provided by applicant): This application, "High deductible health plans: substance abuse service use and cost trajectories," responds to PA-08-174: Economics of Treatment and Prevention Services for Drug & Alcohol Abuse (R01). We propose to examine the impact of high deductible health plans (HDHP) on utilization, costs, and outcomes of patients with substance use (SU) problems over time. We have a unique opportunity to study these questions as Kaiser Permanente Northern California (KPNC) is currently implementing HDHPs. We first examine selection effects in patient characteristics of SU intakes with (and without) the HDHPs across five years (2006-2010) using clinical and administrative health plan data and the electronic medical record (EMR). We then examine 3-year trends in utilization of SU treatment services, medical services, and health care costs by HDHP status for a sample of members who had an intake to SU treatment between 01/2006 and 06/2007 (n=16,313). Finally, we conduct a telephone survey of a cohort of SU treatment intakes from 2009 (n=400) to examine patient knowledge of the HDHP benefits, SU outcomes, and care-seeking behavior in the face of high cost-sharing. This research addresses a key scientific and policy issue: utilization and cost and outcomes of SU treatment in a health care environment that has increasingly turned to HDHP products to control costs by shifting costs to patients. Demand for SU treatment is seen as more price-sensitive than medical care and SU benefits are more limited with higher cost-sharing. This can potentially delay treatment seeking, with increased disease severity and costs over time. The SU population has unique characteristics, including high comorbidities, that may raise the patient risk profile under HDHPs. These individuals often have unanticipated costs such as emergency room visits due to injuries or overdoses. The study is innovative in its use of information technology, including the EMR to examine study questions, and for its clinical implications. Access to the health plan's web-based Outcomes Monitoring System provides baseline epidemiologic information on SU at intake to treatment, enabling a follow-up outcomes survey. We use propensity score analyses to model selection effects and hierarchical linear models for longitudinal analyses. HDHPs are increasingly available and findings have important policy implications outside of KPNC. Findings may improve access to SU treatment, outcomes, reduce costs, and improve patient education and activation. Policy implications include changing benefit designs to include SU treatment as a high value health care service, with low co-payments, or embedding SU treatment services in primary care. PUBLIC HEALTH RELEVANCE: This study examines the impact of high deductible health plans on the use of substance use treatment services, associated costs, and substance use outcomes over time in an integrated health plan. We use the health plan's electronic medical record as well as patient survey data to examine study questions. Study findings will indicate whether patients are delaying care due to high cost-sharing, and if this is related to worsening outcomes and higher downstream costs.

描述（由申请人提供）：本申请“高免赔额健康计划：药物滥用服务的使用和成本轨迹”响应 PA-08-174：药物和酒精滥用治疗和预防服务的经济学 (R01)。我们建议研究高免赔额健康计划 (HDHP) 随着时间的推移对有物质使用 (SU) 问题的患者的利用率、成本和结果的影响。由于北加州凯撒医疗机构 (KPNC) 目前正在实施 HDHP，我们有一个独特的机会来研究这些问题。我们首先使用临床和管理健康计划数据以及电子病历 (EMR) 检查五年（2006-2010）期间有（和没有）HDHP 的 SU 摄入量对患者特征的选择影响。然后，我们以 2006 年 1 月至 2007 年 6 月期间接受 SU 治疗的会员为样本，按 HDHP 状态检查 SU 治疗服务、医疗服务和医疗保健费用的 3 年趋势（n=16,313）。最后，我们对 2009 年以来接受 SU 治疗的队列 (n=400) 进行了电话调查，以检查患者对 HDHP 益处、SU 结果以及面对高额分摊费用时的就医行为的了解。这项研究解决了一个关键的科学和政策问题：医疗保健环境中 SU 治疗的利用、成本和结果，该环境越来越多地转向 HDHP 产品，通过将成本转移给患者来控制成本。人们认为，SU 治疗的需求比医疗保健对价格更敏感，而且 SU 的福利因分摊费用较高而更加有限。这可能会延迟寻求治疗，随着时间的推移，疾病的严重程度和费用都会增加。 SU 人群具有独特的特征，包括高合并症，这可能会提高 HDHP 下患者的风险状况。这些人经常会产生意想不到的费用，例如因受伤或服药过量而去急诊室。该研究的创新之处在于使用信息技术（包括 EMR）来检查研究问题及其临床意义。访问该健康计划的基于网络的结果监测系统可提供接受治疗时 SU 的基线流行病学信息，从而能够进行后续结果调查。我们使用倾向得分分析来模拟选择效应，并使用分层线性模型进行纵向分析。 HDHP 的可用性越来越高，其研究结果对 KPNC 以外的地区也具有重要的政策影响。研究结果可能会改善 SU 治疗的可及性、结果、降低成本并改善患者教育和激活。政策影响包括改变福利设计，将 SU 治疗作为一项高价值的医疗保健服务，共付额较低，或将 SU 治疗服务纳入初级保健。公共卫生相关性：本研究探讨了综合健康计划中高免赔额健康计划对药物滥用治疗服务的使用、相关成本以及药物滥用结果的影响。我们使用健康计划的电子病历以及患者调查数据来检查研究问题。研究结果将表明患者是否因高额分摊费用而推迟护理，以及这是否与恶化的结果和更高的下游成本有关。