Beech Bettina M, Cordier Tristan, Happe Laura E, Trunk Laura, Haugh Gilbert S, Kwong Richard, Gopal Vipin, Beveridge Roy A
Executive Director, Myrlie Evers-Williams Institute, Associate Vice Chancellor for Population Health, and Professor, Family Medicine and Pediatrics, University of Mississippi Medical Center, Jackson.
Manager, Clinical Analytics, Humana, Louisville, KY.
Am Health Drug Benefits. 2017 Apr;10(2):64-71.
Given the positive association between primary care and overall health, several health plans are offering doctors' visits without patient copay, with the intent to increase primary care use. However, the effectiveness of these offers has not been established in the literature.
To evaluate the impact of a free primary care provider (PCP) office visit offered by a health plan on primary care-seeking behaviors.
This nonrandomized concurrent control study used event/trials logistic regression to compare the differences in primary care utilization between new exchange enrollees in Mississippi who were offered a free nonpreventive PCP visit and concurrent controls from Georgia and Tennessee who were not offered a free visit, between January 1, 2014, and December 31, 2014, which was the first year of the exchange plans. Regression models adjusted for age, sex, plan type, rural-urban designation, and enrollment month. Visits to alternative sites of care were also assessed.
The adjusted number of nonpreventive PCP visits did not differ between the states (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.97-1.00). Mississippi residents were significantly more likely to go to the emergency department than the Georgia-Tennessee cohort (OR, 1.33; 95% CI, 1.28-1.39), but they were less likely to visit an urgent care center (OR, 0.10; 95% CI, 0.09-0.11) or a retail clinic (OR, 0.13; 95% CI, 0.11-0.17) than their counterparts.
Despite being eligible for a free nonpreventive visit, enrollees in Mississippi were no more likely than their counterparts in Georgia and Tennessee to visit a PCP. These findings suggest that removing the cost barrier alone may be insufficient to change primary care-seeking behaviors, and other barriers to care should be addressed.
鉴于初级保健与整体健康之间存在正相关关系，一些健康计划提供免费的医生就诊服务，旨在增加初级保健的利用率。然而，这些优惠措施的有效性在文献中尚未得到证实。
评估健康计划提供的免费初级保健提供者（PCP）门诊对寻求初级保健行为的影响。
这项非随机同期对照研究使用事件/试验逻辑回归，比较了2014年1月1日至2014年12月31日（即医保交换计划的第一年）期间，密西西比州获得免费非预防性PCP门诊的新医保交换参保者与佐治亚州和田纳西州未获得免费门诊的同期对照者在初级保健利用率上的差异。回归模型对年龄、性别、计划类型、城乡划分和参保月份进行了调整。还评估了在其他医疗机构的就诊情况。
各州之间非预防性PCP门诊的调整数量没有差异（优势比[OR]，0.99；95%置信区间[CI]，0.97 - 1.00）。密西西比州居民前往急诊科的可能性显著高于佐治亚州 - 田纳西州队列（OR，1.33；95% CI，1.28 - 1.39），但与对照组相比，他们前往紧急护理中心（OR，0.10；95% CI，0.09 - 0.11）或零售诊所（OR，0.13；95% CI，0.11 - 0.17）的可能性较小。
尽管有资格享受免费的非预防性门诊，但密西西比州的参保者前往看PCP的可能性并不比佐治亚州和田纳西州的参保者更高。这些发现表明，仅消除费用障碍可能不足以改变寻求初级保健的行为，还应解决其他就医障碍。
