RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA.
Health Serv Res. 2011 Feb;46(1 Pt 1):173-84. doi: 10.1111/j.1475-6773.2010.01188.x. Epub 2010 Oct 28.
Preventive care has been shown as a high-value health care service. Many employers now offer expanded coverage of preventive care to encourage utilization.
To determine whether expanding coverage is an effective means to encourage utilization.
Comparison of screening rates before and after introduction of deductible-free coverage.
People insured through large corporations between 2002 and 2006.
Preferred Provider Organization (PPO) enrollees from an employer introducing deductible-free coverage, and a control group enrolled in a PPO from a second employer with no policy change.
Adjusted probability of endoscopy, fecal occult blood test (FOBT), lipid screens, mammography, and Papanicolaou (pap) smears.
Introduction of first-dollar coverage (FDC) of preventive services in 2003.
After adjusting for demographics and secular trends, there were between 23 and 78 additional uses per 1,000 eligible patients of covered preventive screens (lipid screens, pap smears, mammograms, and FOBT), with no significant changes in the control group or in a service without FDC (endoscopy).
FDC improves utilization modestly among healthy individuals, particularly those in lower deductible plans. Compliance with guidelines can be encouraged by lowering out-of-pocket costs, but patients' predisposing characteristics merit attention.
预防保健已被证明是一项高价值的医疗服务。许多雇主现在提供更广泛的预防保健覆盖范围，以鼓励利用。
确定扩大覆盖范围是否是鼓励利用的有效手段。
在引入免赔额免费覆盖之前和之后比较筛查率。
2002 年至 2006 年间通过大公司投保的人。
雇主引入免赔额免费覆盖的首选提供商组织 (PPO) 参保人，以及来自第二家雇主的 PPO 参保人，该雇主没有政策变化。
内窥镜检查、粪便潜血试验 (FOBT)、血脂筛查、乳房 X 光检查和巴氏涂片的调整后概率。
2003 年首次引入全额支付（FDC）预防服务。
在调整人口统计学和季节性趋势后，每 1000 名合格患者中有 23 至 78 次额外使用覆盖的预防筛查（血脂筛查、巴氏涂片、乳房 X 光检查和 FOBT），对照组或没有 FDC 的服务（内窥镜检查）没有明显变化。
FDC 适度改善了健康人群的利用率，尤其是那些免赔额较低的计划中的人群。降低自付费用可以鼓励遵守指南，但患者的固有特征值得关注。
