Hibbard Judith H, Greene Jessica, Tusler Martin
University of Oregon.
Med Care Res Rev. 2008 Aug;65(4):437-49. doi: 10.1177/1077558708316686. Epub 2008 Apr 10.
Consumer-driven health plans (CDHPs) are built on the assumption that with increased cost sharing consumers will select cost-effective evidence-based care. In this study, the authors explore whether patterns of utilization change after enrollment in a CDHP and whether the pattern reflects a shift toward evidence-based care. The study population is comprised of 18,025 employees and their adult dependents. The analysis uses a schema for categorizing claims data into high-priority (evidence-based care) and low-priority (limited or no evidence-based care) utilization. The findings indicate that enrollment in CDHPs resulted in a reduction of office visits in the 1st year of enrollment. These reductions in care appear to be indiscriminant, with patients cutting back in both high-and low-priority visits. The reductions in high- and low-priority visits were greater for employees with lower education and income.
消费者驱动型健康计划（CDHPs）基于这样一种假设，即随着成本分担的增加，消费者会选择具有成本效益的循证医疗服务。在本研究中，作者探讨了参保CDHP后使用模式是否发生变化，以及这种模式是否反映了向循证医疗服务的转变。研究人群包括18025名员工及其成年家属。该分析采用了一种将索赔数据分类为高优先级（循证医疗服务）和低优先级（有限或无循证医疗服务）使用情况的模式。研究结果表明，参保CDHP导致参保第一年的门诊就诊次数减少。这些就诊次数的减少似乎是不加区分的，患者在高优先级和低优先级就诊中都有所减少。教育程度和收入较低的员工在高优先级和低优先级就诊中的减少幅度更大。
