Abstract
BackgroundRecent increases in patient cost-sharing for health care have lent increasing importance to monitoring cost-related changes in health care use. Despite the widespread use of survey questions to measure changes in health care use and related behaviors, scant data exists on the reliability of such questions.MethodsWe administered a cross-sectional survey to a stratified random sample of families in a New England health plan's high deductible health plan (HDHP) with ≥ $500 in annualized out-of-pocket expenditures. Enrollees were asked about their knowledge of their plan, information seeking, behavior change associated with having a deductible, experience of delay in care due in part to cost, and hypothetical delay in care due in part to cost. Initial respondents were mailed a follow-up survey within two weeks of each family returning the original survey. We computed several agreement statistics to measure the test-retest reliability for select questions. We also conducted continuity adjusted chi-square, and McNemar tests in both the original and follow-up samples to measure the degree to which our results could be reproduced. Analyses were stratified by self-reported income.ResultsThe test-retest reliability was moderate for the majority of questions (0.41 - 0.60) and the level of test-retest reliability did not differ substantially across each of the broader domains of questions. The observed proportions of respondents with delayed or foregone pediatric, adult, or any family care were similar when comparing the original and follow-up surveys. In the original survey, respondents in the lower-income group were more likely to delay or forego pediatric care, adult care, or any family care. All of the tests comparing income groups in the follow-up survey produced the same result as in the original survey.ConclusionsIn this population of HDHP beneficiaries, we found that survey questions concerning plan knowledge, information seeking, and delayed or foregone care were moderately reliable. Our results offer reassurance for researchers using survey information to study the effects cost sharing on health care utilization.
Highlights
Recent increases in patient cost-sharing for health care have lent increasing importance to monitoring cost-related changes in health care use
The percentage of Americans insured by high deductible health plans (HDHPs) - known as consumer-directed health plans (CDHPs) when combined with a health savings account or health reimbursement account - increased from 8% in 2006 to 17% in 2009
In addition to evaluating the test-retest reliability of select survey questions, we report aggregate differences in information use, health care utilization and delayed or foregone care in order to evaluate how potential changes, due in part to unreliability, might affect the findings of an analysis using a single cross-section of survey data
Summary
Recent increases in patient cost-sharing for health care have lent increasing importance to monitoring cost-related changes in health care use. Despite the widespread use of survey questions to measure changes in health care use and related behaviors, scant data exists on the reliability of such questions. Increases in health care costs have led to increases in patient cost-sharing arrangements such as high deductibles. The effects of cost-sharing arrangements typically have been evaluated in two ways: through analyses of claims data, and through patient surveys that ask about changes in health care decision making and use. Some of the most important data on the effects of increases in cost-sharing for health care in the United States come from surveys [3,4,5].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
