Institute for Health Research, Kaiser Permanente Colorado, Denver, CO.
Center for Integrated Healthcare Research, Kaiser Permanente Hawaii.
Med Care. 2023 Oct 1;61(10):665-673. doi: 10.1097/MLR.0000000000001903. Epub 2023 Aug 10.
In 2015, the Centers for Medicare & Medicaid Services and commercial insurance plans began covering lung cancer screening (LCS) without patient cost-sharing for all plans. We explore the impact of enrolling into a deductible plan on the utilization of LCS services despite having no out-of-pocket cost requirement.
This retrospective study analyzed data from the Population-based Research to Optimize the Screening Process Lung Consortium. Our cohort included non-Medicare LCS-eligible individuals enrolled in managed care organizations between February 5, 2015, and February 28, 2019. We estimate a series of sequential logistic regression models examining utilization across the sequence of events required for baseline LCS. We report the marginal effects of enrollment into deductible plans compared with enrollment in no-deductible plans.
The total effect of deductible plan enrollment was a 1.8 percentage-point (PP) decrease in baseline LCS. Sequential logistic regression results that explore each transition separately indicate deductible plan enrollment was associated with a 4.3 PP decrease in receipt of clinician visit, a 1.7 PP decrease in receipt of LCS order, and a 7.0 PP decrease in receipt of baseline LCS. Reductions persisted across all observable races and ethnicities.
These findings suggest individuals enrolled in deductible plans are more likely to forgo preventive LCS services despite requiring no out-of-pocket costs. This result may indicate that increased cost-sharing is associated with suboptimal choices to forgo recommended LCS. Alternatively, this effect may indicate individuals enrolling into deductible plans prefer less health care utilization. Patient outreach interventions at the health plan level may improve LCS.
2015 年，医疗保险和医疗补助服务中心和商业保险公司开始为所有计划提供肺癌筛查（LCS），而无需患者自付费用。我们探讨了尽管没有自付费用要求，但加入免赔额计划对 LCS 服务利用的影响。
这项回顾性研究分析了基于人群的优化筛查过程肺联盟的数据。我们的队列包括 2015 年 2 月 5 日至 2019 年 2 月 28 日期间参加管理式医疗组织的非医疗保险 LCS 合格个体。我们估计了一系列顺序逻辑回归模型，检查了基线 LCS 所需事件序列中的利用情况。我们报告了与无免赔额计划相比，加入免赔额计划的边际效应。
免赔额计划的加入总效应是基线 LCS 利用减少 1.8 个百分点。单独探索每个转变的顺序逻辑回归结果表明，免赔额计划的加入与临床医生就诊的接受率降低了 4.3 个百分点，LCS 订单的接受率降低了 1.7 个百分点，基线 LCS 的接受率降低了 7.0 个百分点。这种减少在所有可观察到的种族和族裔中都存在。
这些发现表明，尽管没有自付费用，但加入免赔额计划的个体更有可能放弃预防性 LCS 服务。这一结果可能表明，增加自付费用与放弃推荐的 LCS 有关。或者，这种影响可能表明，加入免赔额计划的个体更喜欢减少医疗保健的利用。在健康计划层面进行患者外联干预可能会改善 LCS。
