Division of Research & Modeling, Center for Financing, Access, and Cost Trends, Agency for Healthcare Research & Quality, Rockville, Maryland.
Health Serv Res. 2020 Feb;55(1):119-127. doi: 10.1111/1475-6773.13223. Epub 2019 Oct 27.
To study whether the negative association between enrollment in high-deductible plans and health care utilization is driven by reverse moral hazard or favorable selection, by examining adults with and without a choice of plans.
2011-2016 Medical Expenditure Panel Survey Household Component data on nonelderly adults enrolled in employer-sponsored insurance.
Four types of plans were examined: high-deductible health plans (HDHPs), consumer-directed health plans (CDHPs), low-deductible health plans (LDHPs), and no-deductible health plans (NDHPs). Multivariate logistic regressions of various measures of health care utilization were conducted to estimate the differences in utilization across plan types among those who had a choice of plans and those who did not.
Among adults with a choice of plans, HDHP enrollees had lower levels of utilization compared with those of the NDHP enrollees for any ambulatory visit, any specialist visit, and most preventive services. Among adults without any choice of plans, the differences between HDHP enrollees and NDHP enrollees were not statistically significant.
The differences between those with and without choice of plans in the relationship between HDHP enrollment and health care utilization might possibly be explained by favorable selection.
通过考察有和没有计划选择的成年人，研究参加高免赔额计划与医疗保健利用之间的负相关关系是由反向道德风险还是有利选择驱动的。
2011-2016 年医疗保险支出调查家庭部分关于参加雇主赞助保险的非老年人的数据。
研究考察了四种类型的计划：高免赔额健康计划（HDHPs）、消费者导向健康计划（CDHPs）、低免赔额健康计划（LDHPs）和无免赔额健康计划（NDHPs）。对各种医疗保健利用措施进行了多元逻辑回归，以估计在有和没有计划选择的人群中，不同计划类型之间利用的差异。
在有计划选择的成年人中，与 NDHP 参保人相比，HDHP 参保人在任何门诊就诊、任何专科就诊和大多数预防服务方面的就诊率较低。在没有任何计划选择的成年人中，HDHP 参保人与 NDHP 参保人之间的差异在统计学上没有显著意义。
在 HDHP 参保与医疗保健利用之间的关系中，有和没有计划选择的人群之间的差异可能可以通过有利选择来解释。
