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Economics Risks of and Growth of the High Deductible Health Plan Among Patients With Cognitive Impairment

机译：认知障碍患者高可扣除健康计划的经济学风险和增长

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OBJECTIVES: High Deductible Health Plan (HDHP) is characterized by higher deductibles and lower monthly premiums. Nevertheless, health economists are concerned that HDHPs may reduce or delay needed care, which will ultimately lead to poorer access to care for chronically affected participants. The objectives of this research are 1) to investigate the HDHP enrollment trend over the past decade; and, 2) to determine the effects of HDHP on risks of financial access risks among adults with cognitive impairment (CI). METHODS: Data were obtained between 2010-2018 from National Health Interview Survey (NHIS). Financial access to healthcare was assessed based on 6 survey questions by CDC. For data analysis, simple T tests and Chisq tests were used where appropriate, with multi-variable logistic regressions implemented to evaluate the effects of HDHP on risks of financial access. RESULTS: Of the 103,649 enrollments, 1,148 were with cognitive impairment and 102,501 were without CI diagnosis. A 55% increase in HDHP registers with cognitive impairment was observed from 2010 (30.50%) to 2018 (47.24%). After controlling for confounding variables, patients with HDPHs were more likely to have risks of financial access compared to those without HDHP (OR= 1.313, 95% CI, 1.002-1.719, p=0.0483). CONCLUSIONS: HDHPs are intended to support effective care options and reduce health care costs. Our research among CI patients with HDHP experienced more financial access risks than those without HDHP, indicating that HDHPs might have unintended consequences of healthcare usage. Employers and health care decision-makers may need to consider providing compensation to those HDHP enrollers with CI.
机译：目标：高可扣除健康计划（HDHP）的特点是更高的推出和较低的每月保费。尽管如此，卫生经济学家们担心HDHPS可能会减少或延迟所需的护理，这将最终导致对长期受影响的参与者提供较差的照顾。本研究的目标是1）调查过去十年的HDHP入学趋势; 2）确定HDHP对具有认知障碍（CI）的成年人的财务访问风险风险的影响。方法：从国家卫生面试调查（NHIS）之间的2010-2018之间获得了数据。根据CDC的6个调查问题评估对医疗保健的财务访问。对于数据分析，在适当的情况下使用简单的T测试和CHISQ测试，实现了多变量的逻辑回归来评估HDHP对财务访问风险的影响。结果：103,649名注册，1,148名具有认知障碍，102,501例没有CI诊断。从2010年（30.50％）到2018年（47.24％）观察到认知障碍的HDHP登记册增加55％。在控制混淆变量之后，与没有HDHP的人（OR = 1.313,95％CI，1.002-1.719，P = 0.0483）相比，HDPH的患者更有可能具有金融访问的风险。结论：HDHPS旨在支持有效的护理选择，降低医疗费用。我们在HDHP的CI患者中的研究经历了比没有HDHP的金融访问风险更多，表明HDHPS可能会产生非预期的医疗保健后果。雇主和医疗保健决策者可能需要考虑对与CI的那些HDHP注册提供赔偿。

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