Hu Tiffany Yung-Shin, Ali Iman, Heisler Michele, Levy Helen, Fagerlin Angela, Kullgren Jeffrey T
University of Michigan, Ann Arbor, MI, United States.
Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States.
JMIR Form Res. 2023 Jan 31;7:e37596. doi: 10.2196/37596.
A growing number of Americans are enrolled in high-deductible health plans (HDHPs). Enrollees in HDHPs, particularly those with chronic conditions, face high out-of-pocket costs and often delay or forgo needed care owing to cost. These challenges could be mitigated by the use of cost-conscious strategies when seeking health care, such as discussing costs with providers, saving for medical expenses, and using web-based tools to compare prices, but few HDHP enrollees engage in such cost-conscious strategies. A novel behavioral intervention could enable HDHP enrollees with chronic conditions to adopt these strategies, but it is unknown which intervention features would be most valued and used by this patient population.
This study aimed to assess preferences among HDHP enrollees with chronic conditions for a novel behavioral intervention that supports the use of cost-conscious strategies when planning for and seeking health care.
In an exploratory sequential mixed methods study among HDHP enrollees with chronic conditions, we conducted 20 semistructured telephone interviews and then surveyed 432 participants using a national internet survey panel. Participants were adult HDHP enrollees with diabetes, hypertension, coronary artery disease, chronic obstructive pulmonary disease, or asthma. The interviews and survey assessed participants' health care experiences when using HDHPs and their preferences for the content, modality, and frequency of use of a novel intervention that would support their use of cost-conscious strategies when seeking health care.
Approximately half (11/20, 55%) of the interview participants reported barriers to using cost-conscious strategies. These included not knowing where to find information and worrying that the use of cost-conscious strategies would be very time consuming. Most (18/20, 90%) interviewees who had discussed costs with providers, saved for medical expenses, or used web-based price comparison tools found these strategies to be helpful for managing their health care costs. Most (17/20, 85%) interviewees expressed interest in an intervention delivered through a website or phone app that would help them compare prices for services at different locations. Survey participants were most interested in learning to compare prices and quality, followed by discussing costs with their providers and putting aside money for care, through a website-based or email-based intervention that they would use a few times a year.
Regular use of cost-conscious strategies could mitigate financial barriers faced by HDHP enrollees with chronic conditions. Interventions to encourage the use of cost-conscious strategies should be delivered through a web-based modality and focus on helping these patients in navigating their HDHPs to better manage their out-of-pocket spending.
越来越多的美国人参加了高免赔额健康保险计划（HDHP）。参加HDHP的人，尤其是患有慢性病的人，面临高额的自付费用，并且常常由于费用问题而推迟或放弃所需的治疗。在寻求医疗保健时，通过采用注重成本的策略，例如与医疗服务提供者讨论费用、为医疗费用储蓄以及使用基于网络的工具比较价格等，可以缓解这些挑战，但很少有HDHP参保者采用这种注重成本的策略。一种新颖的行为干预措施可以使患有慢性病的HDHP参保者采用这些策略，但尚不清楚哪些干预特征会受到该患者群体的高度重视和采用。
本研究旨在评估患有慢性病的HDHP参保者对一种新颖的行为干预措施的偏好，该干预措施支持在规划和寻求医疗保健时采用注重成本的策略。
在一项针对患有慢性病的HDHP参保者的探索性序贯混合方法研究中，我们进行了20次半结构化电话访谈，然后使用全国性互联网调查小组对432名参与者进行了调查。参与者为患有糖尿病、高血压、冠状动脉疾病、慢性阻塞性肺疾病或哮喘的成年HDHP参保者。访谈和调查评估了参与者在使用HDHP时的医疗保健经历，以及他们对一种新颖干预措施的内容、形式和使用频率的偏好，该干预措施将支持他们在寻求医疗保健时采用注重成本的策略。
大约一半（11/20，55%）的访谈参与者报告了使用注重成本策略的障碍。这些障碍包括不知道在哪里找到信息，以及担心使用注重成本的策略会非常耗时。大多数（18/20，90%）与医疗服务提供者讨论过费用、为医疗费用储蓄或使用过基于网络的价格比较工具的受访者发现这些策略有助于管理他们的医疗保健成本。大多数（17/20，85%）受访者表示对通过网站或手机应用程序提供的干预措施感兴趣，该措施将帮助他们比较不同地点的服务价格。调查参与者最感兴趣的是学习比较价格和质量，其次是与他们的医疗服务提供者讨论费用以及为护理存钱，通过基于网站或电子邮件的干预措施，他们每年会使用几次。
定期使用注重成本的策略可以缓解患有慢性病的HDHP参保者面临的经济障碍。鼓励使用注重成本策略的干预措施应通过基于网络的形式提供，并侧重于帮助这些患者在HDHP中更好地管理他们的自付费用。
