Center for Child Health Care Studies, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Ave, 6th Fl, Boston, MA 02215, USA.
Am J Manag Care. 2010 Nov;16(11):833-40.
To examine how enrollment in high-deductible health plans (HDHPs) affects use of well-child visits relative to traditional plans, when preventive care is exempt from the deductible.
Pre-post comparison between groups.
We selected children aged <18 years enrolled in a large Massachusetts health plan through employers offering only 1 type of plan. Children were in traditional plans for a 12-month baseline period between 2001 and 2004, then were either switched by a decision of the parent's employer to an HDHP or kept in the traditional plan (controls) for a 12-month follow-up period. Preventive and other office visits were exempt from the deductible and subject to copayments, as in traditional plans. The primary outcome was whether the child received well-child visits recommended for the 12-month period. Using generalized linear mixed models, we compared the change in receipt of recommended well-child visits between baseline and follow-up for the HDHP group relative to controls.
We identified 1598 children who were switched to HDHPs and 10,093 controls. Between baseline and follow-up, the mean proportion of recommended well-child visits received by HDHP children decreased slightly from 0.846 to 0.841, and from 0.861 to 0.855 for controls. In adjusted models, there was no significant difference in the change in probability that recommended well-child visits were received by HDHP children compared with controls (P = .69).
Receipt of recommended well-child visits did not change for children switching from traditional plans to HDHPs that exempt preventive care from the deductible.
考察在免赔额健康计划（HDHPs）中，当预防保健服务免除免赔额时，与传统计划相比，参保人登记参加 HDHPs 对儿童健康访视的使用情况的影响。
组间前后比较。
我们选择了在雇主仅提供 1 种计划的马萨诸塞州大型健康计划中登记的<18 岁儿童。儿童在 2001 年至 2004 年期间的 12 个月基线期内参加传统计划，然后根据父母雇主的决定切换到 HDHP 或继续参加传统计划（对照组），随访期为 12 个月。预防保健和其他门诊就诊均免除免赔额，并按传统计划收取共付额。主要结局是儿童是否接受了 12 个月期间推荐的儿童健康访视。使用广义线性混合模型，我们比较了 HDHP 组和对照组在基线期和随访期之间接受推荐的儿童健康访视的变化。
我们确定了 1598 名切换到 HDHP 的儿童和 10093 名对照组儿童。在基线期和随访期之间，接受推荐的儿童健康访视的 HDHP 儿童的比例从 0.846 略有下降至 0.841，对照组从 0.861 下降至 0.855。在调整后的模型中，与对照组相比，接受推荐的儿童健康访视的 HDHP 儿童的变化概率无显著差异（P =.69）。
对于从传统计划切换到免赔额中免除预防保健服务的 HDHPs 的儿童，推荐的儿童健康访视的接受率没有变化。
