Brown University, Providence, Rhode Island.
University of Michigan, Ann Arbor.
JAMA Health Forum. 2024 Aug 2;5(8):e242614. doi: 10.1001/jamahealthforum.2024.2614.
Enrollee cost-sharing and health insurance premiums have grown alongside rising hospital prices. To control prices and price growth, the Oregon State Employee plan instituted a cap on hospital facility payments in October 2019 that was found to reduce hospital prices. Yet the program's association with out-of-pocket spending and use among enrollees is unknown.
To assess the association of the Oregon State Employee Plan's hospital payment cap with out-of-pocket spending and changes in service use among state employees enrolled in higher cost-sharing plans.
DESIGN, SETTING, AND PARTICIPANTS: Using data from the Oregon All Payer All Claims database (January 2014 to December 2021), a difference-in-differences analysis was conducted to examine the association of Oregon's hospital payment cap with enrollee out-of-pocket spending and service use. The main analysis focused on the outpatient setting, where there were significant declines in hospital prices. Changes in a subpopulation of employees enrolled in higher cost-sharing plans were also examined.
The primary outcome was outpatient out-of-pocket spending per procedure, which included the copayment, coinsurance, and/or deductible paid at the point of service. Changes in service use were also examined by counting the number of outpatient procedures received per enrollee per year.
The outpatient sample included 1 094 083 procedures from 92 523 Oregon educators and 4 510 342 procedures from 473 621 control enrollees. During the period before implementation, Oregon educators had higher out-of-pocket spending per outpatient procedure than the control group ($69.26 vs $41.87). The hospital payment cap was associated with a $6.60, or 9.5%, reduction in out-of-pocket spending per procedure (95% CI, -12.7 to -0.5) and a 0.24, or 4.8%, increase in the number of outpatient procedures received per enrollee per year (95% CI, 0.09-0.39) among those in higher cost-sharing plans. Enrollees receiving outpatient services from October 2019 through December 2021 saved an estimated $1.8 million. However, savings for the state were $10.3 million less than they would have been absent increases in service use.
The study findings suggest that enrollees may benefit from reduced out-of-pocket spending due to hospital price regulations, but states should be mindful that price regulations may inadvertently increase health care service use.
随着医院价格的上涨，参保人自付费用和医疗保险费也在增加。为了控制价格和价格增长，俄勒冈州员工计划于 2019 年 10 月对医院设施支付实行了上限，事实证明这降低了医院的价格。然而，该计划与参保人自付支出和使用之间的关系尚不清楚。
评估俄勒冈州员工计划的医院支付上限与高自付费用计划参保人的自付支出和服务使用变化之间的关联。
设计、设置和参与者：使用俄勒冈州所有支付者所有索赔数据库的数据（2014 年 1 月至 2021 年 12 月），采用差异中的差异分析来检验俄勒冈州医院支付上限与参保人自付支出和服务使用之间的关系。主要分析集中在门诊环境，那里的医院价格有显著下降。还检查了高自付费用计划参保人中一个亚人群的变化。
主要结果是每次就诊的门诊自付支出，包括在服务点支付的共同支付额、自付额和/或免赔额。还通过计算每位参保人每年的门诊就诊次数来检查服务使用的变化。
门诊样本包括 92523 名俄勒冈州教育工作者的 1094083 次就诊和 473621 名对照参保人的 4510342 次就诊。在实施前的一段时间内，俄勒冈州教育工作者每次门诊就诊的自付支出高于对照组（69.26 美元对 41.87 美元）。医院支付上限与每次就诊的自付支出减少 6.60 美元（95%置信区间，-12.7 至 -0.5）和每名参保人每年接受的门诊就诊次数增加 0.24 次（95%置信区间，0.09 至 0.39）有关，这与高自付费用计划中的人群有关。接受 2019 年 10 月至 2021 年 12 月门诊服务的参保人估计节省了 180 万美元。然而，由于服务使用的增加，州政府的节省额比没有增加的情况下减少了 1030 万美元。
研究结果表明，由于医院价格监管，参保人可能会从减少自付支出中受益，但各州应注意，价格监管可能会无意中增加医疗服务的使用。
