初入保险计划时：与加入健康保险计划头几年相关的医疗保健使用情况
On being new to an insurance plan: health care use associated with the first years in a health insurance plan.
作者信息
Franks Peter, Cameron Colin, Bertakis Klea D
机构信息
Center for Health Services Research in Primary Care and Department of Family and Community Medicine, University of California, Davis, Sacramento, Calif 95817, USA.
出版信息
Ann Fam Med. 2003 Sep-Oct;1(3):156-61. doi: 10.1370/afm.24.
BACKGROUND
We wanted to compare health care utilization and costs in the first year of being in a health insurance plan with those of subsequent years.
METHODS
We used claims data from an independent practitioner association (IPA)-style managed care organization in the Rochester, NY, metropolitan area from 1996 through 1999. Cross-sectional and panel analyses of up to 4 years of claims data were conducted, involving 335,547 adult patients assigned to the panels of 687 primary care physicians (internists and family physicians). Multivariate analyses, adjusting for age, sex, case mix, and socioeconomic status derived from ZIP codes, examined the relationship between the first year of health insurance and Papanicolaou tests, mammograms in women older than 40 years, physician use, avoidable hospitalization, and expenditures.
RESULTS
After multivariate adjustment, the first year of insurance was associated with a higher risk of not getting a mammogram, a higher risk of avoidable hospitalization, greater likelihood of visiting a physician, and higher expenditures, especially for testing. There was no relationship, however, between Papanicolaou test compliance and year of enrollment.
CONCLUSIONS
The findings suggest there might be adverse clinical and financial implications associated with changing insurance.
背景
我们希望比较加入健康保险计划第一年的医疗保健利用情况和费用与随后几年的情况。
方法
我们使用了1996年至1999年纽约罗切斯特大都市地区一个独立从业者协会（IPA）式管理式医疗组织的理赔数据。对长达4年的理赔数据进行了横断面分析和面板分析，涉及分配给687名初级保健医生（内科医生和家庭医生）小组的335,547名成年患者。多变量分析在调整了年龄、性别、病例组合以及根据邮政编码得出的社会经济地位后，研究了健康保险第一年与巴氏试验、40岁以上女性的乳房X光检查、医生就诊、可避免的住院治疗及支出之间的关系。
结果
经过多变量调整后，保险第一年与未进行乳房X光检查的较高风险、可避免住院治疗的较高风险、看医生的可能性增加以及较高支出相关，尤其是检查方面的支出。然而，巴氏试验的依从性与参保年份之间没有关系。
结论
研究结果表明，更换保险可能会带来不良的临床和财务影响。
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