*Harvard University PhD Program in Health Policy, Cambridge, MA †Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute ‡Department of Health Care Policy, Harvard Medical School, Boston, MA.
Med Care. 2014 Jan;52(1):86-92. doi: 10.1097/MLR.0000000000000008.
By shifting a greater share of out-of-pocket medical costs to consumers, high-deductible health plans (HDHP) might discourage use of essential outpatient services.
The objective of the study was to examine the impact of an HDHP on outpatient visits and associated laboratory and radiology tests.
RESEARCH DESIGN/SUBJECTS: We used a pre-post with comparison group study design to examine the differential change in outpatient service utilization among 7953 adults who were switched from a traditional Health Maintenance Organization plan to an HDHP compared with 7953 adults remaining in traditional plans. HDHP members had full coverage of preventive laboratory tests and modest copayments for outpatient visits, similar to controls, but faced full cost sharing under the deductible for radiology tests and laboratory tests not classified as preventive.
Compared with controls, the HDHP group experienced moderate relative decreases in overall office visits (incidence rate ratios = 0.91, or a 9% relative reduction; 95% confidence interval: 0.88, 0.94) and visits for higher-priority (0.91; 0.85, 0.97) and lower-priority (0.89; 0.81, 0.99) chronic conditions. There were no significant differences in changes in visit rates for acute higher-priority or lower-priority conditions (both 0.93; 0.86, 1.01) or preventive laboratory tests (0.97; 0.93, 1.02). HDHP members showed moderate relative reductions in the use of general laboratory tests (0.91; 0.86, 0.97) but not radiology tests (0.97; 0.91, 1.03).
Chronic outpatient visits declined among HDHP members, although preventive laboratory tests and acute visits remained unchanged. HDHP patients with chronic illnesses who have more contact with the health care system might be more likely to reduce utilization because of increased exposure to costs associated with ambulatory visits.
通过将更多的自付医疗费用转嫁给消费者，高免赔额健康计划（HDHP）可能会抑制基本门诊服务的使用。
本研究旨在考察 HDHP 对门诊就诊次数以及相关实验室和放射学检查的影响。
研究设计/研究对象：我们采用前后对照的研究设计，对 7953 名从传统健康维护组织计划转为 HDHP 的成年人与仍留在传统计划中的 7953 名成年人的门诊服务利用情况的差异变化进行了研究。HDHP 参保者的所有预防实验室检查均全额覆盖，门诊就诊只需支付适度的共同支付额，与对照组相似，但对于放射学检查和未被归类为预防的实验室检查，则需要在扣除免赔额后全额承担费用。
与对照组相比，HDHP 组的整体门诊就诊次数（发病率比=0.91，即相对减少 9%；95%置信区间：0.88，0.94）以及高优先级（0.91；0.85，0.97）和低优先级（0.89；0.81，0.99）慢性疾病的就诊次数均出现适度的相对减少。急性高优先级或低优先级疾病就诊率（均为 0.93；0.86，1.01）或预防实验室检查（0.97；0.93，1.02）的变化均无显著差异。HDHP 参保者一般实验室检查的使用量适度减少（0.91；0.86，0.97），但放射学检查的使用量没有变化（0.97；0.91，1.03）。
HDHP 参保者的慢性门诊就诊次数有所下降，尽管预防实验室检查和急性就诊次数保持不变。那些与医疗保健系统有更多接触的患有慢性病的 HDHP 患者，由于与门诊就诊相关的费用增加，可能更有可能减少使用。
