Shekelle P G, Rogers W H, Newhouse J P
West Los Angeles Department of Veterans Affairs Medical Center, California, USA.
Med Care. 1996 Sep;34(9):863-72. doi: 10.1097/00005650-199609000-00001.
Chiropractic care is increasing in the United States, and there are few data about the effect of cost sharing on the use of chiropractic services. This study calculates the effect of cost sharing on chiropractic use.
The authors analyzed data from the RAND Health Insurance Experiment, a randomized controlled trial of the effect of cost sharing on the use of health services. Families in six US sites were randomized to receive fee-for-service care that was free or required one of several levels of cost sharing, or to receive care from a health maintenance organization (HMO). Enrollees were followed for 3 or 5 years. All fee-for-service plans covered chiropractic services. Persons assigned to the HMO experimental group received free fee-for-service chiropractic care; persons in the HMO control group had 95% cost sharing for chiropractic services. The authors calculated the mean annual chiropractic expense per person in each of the fee-for-service plans, and also predicted their chiropractic expenditures using a two-equation model. Chiropractic use among persons receiving HMO and fee-for-service care were compared.
Chiropractic care is very sensitive to price, with any level of coinsurance of 25% or greater decreasing chiropractic expenditures by approximately half. Access to free chiropractic care among HMO enrollees increased chiropractic use ninefold, whereas access to free medical care decreased fee-for-service chiropractic care by 80%.
Chiropractic care is more sensitive to price than general medical care, outpatient medical care, or dental care, or and nearly as sensitive as outpatient mental health care. A substantial cross-price effect with medical care may exist.
在美国，整脊治疗的使用正在增加，但关于费用分担对整脊服务使用的影响的数据却很少。本研究计算了费用分担对整脊治疗使用的影响。
作者分析了兰德健康保险实验的数据，这是一项关于费用分担对医疗服务使用影响的随机对照试验。美国六个地点的家庭被随机分配接受免费的按服务收费医疗、需要承担几种费用分担水平之一的按服务收费医疗，或接受健康维护组织（HMO）的医疗服务。对参与者进行了3年或5年的跟踪。所有按服务收费计划都涵盖整脊服务。被分配到HMO实验组的人接受免费的按服务收费整脊治疗；HMO对照组的人在整脊服务上需承担95%的费用。作者计算了每个按服务收费计划中每人每年的平均整脊费用，并使用双方程模型预测了他们的整脊支出。比较了接受HMO和按服务收费医疗的人群的整脊治疗使用情况。
整脊治疗对价格非常敏感，任何25%或更高的共保水平都会使整脊支出减少约一半。HMO参保者能够获得免费整脊治疗使整脊治疗的使用增加了九倍，而能够获得免费医疗服务则使按服务收费的整脊治疗减少了80%。
整脊治疗比一般医疗、门诊医疗或牙科护理对价格更敏感，几乎与门诊心理健康护理一样敏感。可能存在与医疗服务的显著交叉价格效应。
