Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA.
Med Care. 2013 Aug;51(8):639-45. doi: 10.1097/MLR.0b013e31829742d0.
Prior studies show that men are more likely than women to defer essential care. Enrollment in high-deductible health plans (HDHPs) could exacerbate this tendency, but sex-specific responses to HDHPs have not been assessed. We measured the impact of an HDHP separately for men and women.
Controlled longitudinal difference-in-differences analysis of low, intermediate, and high severity emergency department (ED) visits and hospitalizations among 6007 men and 6530 women for 1 year before and up to 2 years after their employers mandated a switch from a traditional health maintenance organization plan to an HDHP, compared with contemporaneous controls (18,433 men and 19,178 women) who remained in an health maintenance organization plan.
In the year following transition to an HDHP, men substantially reduced ED visits at all severity levels relative to controls (changes in low, intermediate, and high severity visits of -21.5% [-37.9 to -5.2], -21.6% [-37.4 to -5.7], and -34.4% [-62.1 to -6.7], respectively). Female HDHP members selectively reduced low severity emergency visits (-26.9% [-40.8 to -13.0]) while preserving intermediate and high severity visits. Male HDHP members also experienced a 24.2% [-45.3 to -3.1] relative decline in hospitalizations in year 1, followed by a 30.1% [2.1 to 58.1] relative increase in hospitalizations between years 1 and 2.
Initial across-the-board reductions in ED and hospital care followed by increased hospitalizations imply that men may have foregone needed care following an HDHP transition. Clinicians caring for patients with HDHPs should be aware of sex differences in response to benefit design.
先前的研究表明，男性比女性更有可能推迟基本治疗。参加高免赔额健康计划（HDHP）可能会加剧这种趋势，但尚未评估 HDHP 对男性和女性的具体影响。我们分别测量了 HDHP 对男性和女性的影响。
对 6007 名男性和 6530 名女性在其雇主将传统健康维护组织计划转换为 HDHP 前后 1 年期间和最多 2 年期间的低、中、高严重程度急诊就诊和住院情况进行控制的纵向差异差异分析，并与同时期的对照组（18433 名男性和 19178 名女性）进行比较，这些对照组仍留在健康维护组织计划中。
在过渡到 HDHP 的一年后，男性与对照组相比，所有严重程度的急诊就诊量都大幅减少（低、中、高严重程度就诊量的变化分别为-21.5%[-37.9 至-5.2]、-21.6%[-37.4 至-5.7]和-34.4%[-62.1 至-6.7]）。女性 HDHP 成员选择性地减少了低严重程度的急诊就诊量（-26.9%[-40.8 至-13.0]），同时保留了中、高严重程度的就诊量。男性 HDHP 成员在第 1 年还经历了 24.2%[-45.3 至-3.1]的住院率相对下降，随后在第 1 年和第 2 年之间，住院率相对增加了 30.1%[2.1 至 58.1]。
最初全面减少急诊和住院治疗，随后增加住院治疗，这意味着男性在 HDHP 过渡后可能放弃了所需的治疗。照顾 HDHP 患者的临床医生应该注意到受益设计对男性和女性反应的差异。
