Galbraith Alison A, Ross-Degnan Dennis, Soumerai Stephen B, Miroshnik Irina, Wharam J Frank, Kleinman Kenneth, Lieu Tracy A
Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care, Harvard Medical School, 133 Brookline Ave, 6th floor Boston, MA 02215, USA.
Pediatrics. 2009 Apr;123(4):e589-94. doi: 10.1542/peds.2008-1738.
There is concern that high-deductible health plans may have negative effects on vulnerable groups. The objective of this study was to compare the characteristics of families who have children and switch to high-deductible health plans with those who stay in traditional plans.
This double-cohort study included families who had children aged <18 years and were enrolled in a Massachusetts health plan through employers who did not offer a choice of health plans. We identified families who had traditional health maintenance organization plans for a 12-month baseline period between 2001 and 2004 and compared families whose coverage was then switched to a high-deductible health plan by their employers with similar families whose employer chose to remain in the traditional plan (controls). Data came from health plan enrollment and claims datasets and census data. We used multivariate logistic regression models to compare the characteristics of families who were switched to high-deductible health plans with controls.
We identified 839 families who had children and whose employer switched them to high-deductible health plans and 5133 controls. Among families with large employers, the adjusted odds of the employer switching to a high-deductible health plan were higher for families living in high-poverty neighborhoods. Among families with small employers, the adjusted odds of the employer switching to a high-deductible health plan were lower for families with more children, above-average family morbidity, and baseline total expenditures >$7000.
Among families with large employers offering a single health plan, those from low-income neighborhoods are more likely to be switched to high-deductible health plans. In contrast, families with small employers offering a single plan are more likely to be switched to high-deductible health plans if they are healthier and have lower baseline costs. These findings suggest that families with children in high-deductible plans may represent two distinct groups, one with higher-risk characteristics and another with lower-risk characteristics compared with those in traditional plans.
人们担心高免赔额健康保险计划可能会对弱势群体产生负面影响。本研究的目的是比较有孩子且转而参加高免赔额健康保险计划的家庭与仍参加传统保险计划的家庭的特征。
这项双队列研究纳入了有18岁以下子女且通过雇主参加马萨诸塞州健康保险计划（雇主未提供健康保险计划选择）的家庭。我们确定了在2001年至2004年期间有12个月基线期参加传统健康维护组织计划的家庭，并将那些保险范围随后被雇主转为高免赔额健康保险计划的家庭与雇主选择继续参加传统计划的类似家庭（对照组）进行比较。数据来自健康保险计划登记和理赔数据集以及人口普查数据。我们使用多变量逻辑回归模型来比较转而参加高免赔额健康保险计划的家庭与对照组的特征。
我们确定了839个有孩子且雇主将其转为高免赔额健康保险计划的家庭以及5133个对照组家庭。在大雇主的家庭中，居住在高贫困社区的家庭，雇主转而参加高免赔额健康保险计划的调整后几率更高。在小雇主的家庭中，孩子较多、家庭发病率高于平均水平且基线总支出>7000美元的家庭，雇主转而参加高免赔额健康保险计划的调整后几率较低。
在提供单一健康保险计划的大雇主家庭中，来自低收入社区的家庭更有可能被转为高免赔额健康保险计划。相比之下，提供单一计划的小雇主家庭如果更健康且基线成本较低，则更有可能被转为高免赔额健康保险计划。这些发现表明，参加高免赔额计划的有孩子家庭可能代表两个不同的群体，与参加传统计划的家庭相比，一个具有较高风险特征，另一个具有较低风险特征。
