高自付额保险与糖尿病大血管并发症治疗延迟。
High-Deductible Insurance and Delay in Care for the Macrovascular Complications of Diabetes.
机构信息
Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (J.F.W., C.Y.L., F.Z., M.C., X.X., J.W., S.S., D.R.).
Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, and Harvard Kennedy School and National Bureau of Economic Research, Cambridge, Massachusetts (J.P.N.).
出版信息
Ann Intern Med. 2018 Dec 18;169(12):845-854. doi: 10.7326/M17-3365. Epub 2018 Nov 20.
BACKGROUND
Little is known about the long-term effects of high-deductible insurance on care for chronic medical conditions.
OBJECTIVE
To determine whether a transition from low-deductible to high-deductible insurance is associated with delayed medical care for macrovascular complications of diabetes.
DESIGN
Observational longitudinal comparison of matched groups.
SETTING
A large national health insurer during 2003 to 2012.
PARTICIPANTS
The intervention group comprised 33 957 persons with diabetes who were continuously enrolled in low-deductible (≤$500) insurance plans during a baseline year followed by up to 4 years in high-deductible (≥$1000) plans. The control group included 294 942 persons with diabetes who were enrolled in low-deductible plans contemporaneously with matched intervention group members.
INTERVENTION
Employer-mandated transition to a high-deductible plan.
MEASUREMENTS
The number of months it took for persons in each study group to seek care for their first major macrovascular symptom, have their first major diagnostic test for macrovascular disease, and have their first major procedure-based treatment was determined. Between-group differences in time to reach a midpoint event rate were then calculated.
RESULTS
No baseline differences were found between groups. During follow-up, the delay for the high-deductible group was 1.5 months (95% CI, 0.8 to 2.3 months) for seeking care for the first major symptom, 1.9 months (CI, 1.4 to 2.3 months) for the first diagnostic test, and 3.1 months (CI, 0.5 to 5.8 months) for the first procedure-based treatment.
LIMITATION
Health outcomes were not examined.
CONCLUSION
Among persons with diabetes, mandated enrollment in a high-deductible insurance plan was associated with delays in seeking care for the first major symptoms of macrovascular disease, the first diagnostic test, and the first procedure-based treatment.
PRIMARY FUNDING SOURCE
National Institute of Diabetes and Digestive and Kidney Diseases.
背景
对于高免赔额保险对慢性疾病治疗的长期影响知之甚少。
目的
确定从低免赔额保险过渡到高免赔额保险是否与糖尿病大血管并发症的医疗延迟有关。
设计
匹配组的观察性纵向比较。
设置
2003 年至 2012 年期间，一家大型全国性健康保险公司。
参与者
干预组包括 33957 名连续参加低免赔额（≤500 美元）保险计划的糖尿病患者，在基线年后最多有 4 年参加高免赔额（≥1000 美元）计划。对照组包括 294942 名同时参加低免赔额计划的糖尿病患者，与干预组成员相匹配。
干预措施
雇主强制过渡到高免赔额计划。
测量
确定每个研究组的人员寻求首次大血管症状治疗、首次大血管疾病主要诊断性检查和首次主要基于程序的治疗所需的月数。然后计算达到中点事件率的组间差异时间。
结果
两组之间没有发现基线差异。在随访期间，高免赔额组在寻求首次主要症状治疗方面延迟了 1.5 个月（95%CI，0.8 至 2.3 个月），首次诊断性检查延迟了 1.9 个月（CI，1.4 至 2.3 个月），首次基于程序的治疗延迟了 3.1 个月（CI，0.5 至 5.8 个月）。
局限性
未检查健康结果。
结论
在糖尿病患者中，强制参加高免赔额保险计划与寻求大血管疾病的首次主要症状、首次诊断性检查和首次基于程序的治疗的延迟有关。
主要资金来源
美国国立糖尿病、消化和肾脏疾病研究所。
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