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远程医疗支付平价与门诊服务利用:来自私人保险员工的证据

Telehealth payment parity and outpatient service utilization: evidence from privately insured workers.

作者信息

Zhang Zhang, Bundorf M Kate, Gong Qing, Shea Christopher M, Gilleskie Donna, Sylvia Sean Y

机构信息

Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill 27599, United States.

Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill 27516, United States.

出版信息

Health Aff Sch. 2025 Apr 1;3(4):qxaf068. doi: 10.1093/haschl/qxaf068. eCollection 2025 Apr.

DOI:10.1093/haschl/qxaf068
PMID:40264702
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12013821/
Abstract

Telehealth was catalyzed by the COVID-19 pandemic and has become a new norm in healthcare. In response to the pandemic, some states passed telehealth payment parity legislation, mandating equal payment rates for telehealth and in-person services. We evaluated the relationship between telehealth payment parity and health service utilization, focusing on insured workers in commercial insurance plans. Using the Merative Commercial Claims and Encounters database from 2019 to 2021, we leverage variation in the timing of policy changes across states using a difference-in-difference approach. Payment parity was significantly associated with increased telehealth visits and total outpatient visits but without a notable rise in in-person visits. Furthermore, payment parity was pronounced in increasing telehealth utilization within self-funded large employer plans, while not significantly associated with telehealth visits among fully insured small employer plans. Our findings underscore the important role of payment parity in increasing telehealth service utilization by incentivizing providers. Future policies should support the sustainable integration of telehealth services, shifting from solely focusing on equal payment rates to adopting value-based reimbursement models that improve equitable healthcare access for all employees in commercial insurance.

摘要

远程医疗因新冠疫情而得到催化,已成为医疗保健领域的一种新常态。为应对疫情,一些州通过了远程医疗支付平价立法,规定远程医疗服务和面对面服务的支付费率相等。我们评估了远程医疗支付平价与医疗服务利用之间的关系,重点关注商业保险计划中的参保员工。利用2019年至2021年的艾美仕商业理赔和诊疗数据库,我们采用双重差分法利用各州政策变化时间的差异。支付平价与远程医疗就诊次数和门诊总就诊次数的增加显著相关,但面对面就诊次数没有明显增加。此外,支付平价在增加自筹资金的大型雇主计划中的远程医疗利用率方面表现明显,而与全额保险的小型雇主计划中的远程医疗就诊次数没有显著关联。我们的研究结果强调了支付平价在通过激励提供者来提高远程医疗服务利用率方面的重要作用。未来的政策应支持远程医疗服务的可持续整合,从单纯关注支付费率平等转向采用基于价值的报销模式,以改善商业保险中所有员工的公平医疗服务可及性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf51/12013821/5658611aceef/qxaf068f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf51/12013821/774f09ab9c01/qxaf068f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf51/12013821/5658611aceef/qxaf068f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf51/12013821/774f09ab9c01/qxaf068f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bf51/12013821/5658611aceef/qxaf068f2.jpg

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本文引用的文献

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Impact of State Telehealth Parity Laws for Private Payers on Hypertension Medication Adherence Before and During the COVID-19 Pandemic.私人支付者的州远程医疗均等化法律对高血压药物治疗依从性的影响:在 COVID-19 大流行之前和期间。
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Impact of state telehealth policies on telehealth use among patients with newly diagnosed cancer.州远程医疗政策对新诊断癌症患者远程医疗使用的影响。
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3
Payment and Coverage Parity for Virtual Care and In-Person Care: How Do We Get There?
虚拟护理和面对面护理的支付与覆盖平等:我们如何实现?
Telemed Rep. 2023 May 18;4(1):100-108. doi: 10.1089/tmr.2023.0014. eCollection 2023.
4
Disparities in telehealth access, not willingness to use services, likely explain rural telehealth disparities.农村远程医疗服务的差异可能是由于远程医疗获取方面的差异,而不是服务使用意愿的差异。
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The Impact of Telemedicine Parity Requirements on Telehealth Utilization in the United States During the COVID-19 Pandemic.新冠疫情期间美国的远程医疗均等化要求对远程医疗利用率的影响。
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6
The Health Plan Environment In California Contributed To Differential Use Of Telehealth During The COVID-19 Pandemic.加利福尼亚州的医保环境促成了 COVID-19 大流行期间远程医疗的差异化使用。
Health Aff (Millwood). 2022 Dec;41(12):1812-1820. doi: 10.1377/hlthaff.2022.00464.
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JAMA Netw Open. 2022 Oct 3;5(10):e2236524. doi: 10.1001/jamanetworkopen.2022.36524.
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