Department of Preventive Medicine, University of Tennessee Health Science Center, 66 North Pauline St, Suite 633, Memphis, TN 38163, USA.
Health Serv Res. 2011 Feb;46(1 Pt 1):155-72. doi: 10.1111/j.1475-6773.2010.01191.x. Epub 2010 Oct 28.
High-deductible health plans (HDHPs) are of high interest to employers, policy makers, and insurers because of potential benefits and risks of this fundamentally new coverage model.
To investigate the impact of HDHPs on health care utilization and costs in a heterogeneous group of enrollees from a variety of individual and employer-based health plans.
Claims and member data from a major insurer and zip code-level census data.
Retrospective difference-in-differences analyses were used to examine the impact of HDHP plans. This analytical approach compared changes in utilization and expenditures over time (2007 versus 2005) across the two comparison groups (HDHP switchers versus matched PPO controls).
In two-part models, HDHP enrollment was associated with reduced emergency room use, increases in prescription medication use, and no change in overall outpatient expenditures. The impact of HDHPs on utilization differed by subgroup. Chronically ill enrollees and those who clearly had a choice of plans were more likely to increase utilization in specific categories after switching to an HDHP plan.
Whether HDHPs are associated with lower costs is far from settled. Various subgroups of enrollees may choose HDHPs for different reasons and react differently to plan incentives.
高自付额健康计划（HDHPs）引起了雇主、政策制定者和保险公司的极大兴趣，因为这种全新的保险模式具有潜在的利益和风险。
研究 HDHPs 在来自各种个人和雇主健康计划的异质参保人群中对医疗保健利用和成本的影响。
来自一家主要保险公司的索赔和会员数据以及邮政编码级别的普查数据。
采用回顾性差异-差异分析来检验 HDHP 计划的影响。这种分析方法比较了两个比较组（HDHP 转换者与匹配的 PPO 对照组）在两个时间段（2007 年与 2005 年）之间的利用和支出变化。
在两部分模型中，HDHP 参保与急诊室就诊减少、处方药使用增加有关，而总门诊支出没有变化。HDHPs 的利用影响因亚组而异。慢性病患者和那些明显有选择计划的人在切换到 HDHP 计划后，更有可能在特定类别中增加利用。
HDHPs 是否与降低成本有关还远未确定。参保人群的各种亚组可能出于不同的原因选择 HDHPs，并对计划激励做出不同的反应。
