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PubMed2005

Physician strategies to reduce patients' out-of-pocket prescription costs.

BACKGROUND: Physicians often do not communicate with patients about out-of-pocket costs, although research indicates that physicians and patients value such discussion. METHODS: Cross-sectional national random sample mail survey of 1400 cardiologists and general internists to quantify barriers to communication about out-of-pocket costs and strategies used to assist patients in order of likelihood (from 5 [extremely likely] to 1 [not at all likely]). RESULTS: Overall, 519 (39.1%) of 1328 eligible physicians responded to the survey. The most common barriers were lack of habit, insufficient time, and concern over patient discomfort. The most common strategies used to assist patients were switching to a generic drug (mean, 4.34; SD, 0.86), using office samples (mean, 4.16; SD, 1.22), and discontinuing nonessential medicines (mean, 4.03; SD, 0.99). There were no statistically significant differences between cardiologists and general internists in barriers or strategies examined (P<.05). CONCLUSIONS: Our findings suggest that patient-physician communication about out-of-pocket costs is a problem affecting specialists and generalists nationwide. Despite barriers, physicians use multiple strategies that may vary in efficacy to assist patients burdened by these costs.

Adult↗
PubMed2003

Patient preferences for eye drop characteristics: a willingness-to-pay analysis.

OBJECTIVE: To determine the importance that patients place on the characteristics of topical therapy for lowering intraocular pressure. METHODS: We administered a willingness-to-pay instrument to 230 patients from 4 glaucoma subspecialty practices, asking them how much they would be willing to pay to obtain particular characteristics in an eye drop. Data about the subjects' demographics, economic status, attitudes toward eye drops and systemic medications, and symptoms from eye drops were correlated with their willingness to pay using 2-part models. RESULTS: Of our subjects, 169 (77%) were using eye drops to lower their intraocular pressure. Fatigue, blurred vision, and tearing were the most commonly reported symptoms. Eye drop medications most valued by the subjects did not produce blurring, drowsiness, or inhibition of sexual performance; 85% were willing to pay more for an eye drop that did not cause blurring, and on average they were willing to pay 40% more. Higher educational levels and income were generally associated with a willingness to pay more for eye drops with desirable attributes. MAIN OUTCOME MEASURE: Willingness to pay more (in dollars). CONCLUSIONS: Patient preferences for eye drop characteristics can be assessed using a willingness-to-pay instrument. Patients place differing value on various eye drop characteristics. A better understanding of patient preference could lead to better compliance.

Aged↗
PubMed1997

The case for medical savings accounts.

The debate about health care reform has centered around managed care and its ramifications. Medical savings accounts (MSAs), on the other hand, have been relegated to the background of the congressional discussion of health care reform. Conservative Republicans have advocated MSAs, whereas they have been denigrated by many liberals. The Clinton administration has threatened to veto any legislation that includes MSA provisions. I believe that MSAs are in general poorly understood by physicians and deserve closer attention. This article will explain what MSAs are and how they work. The advantages of MSAs will be discussed and examples of MSAs in action will be provided.

Cost Sharing↗
PubMed2005

A national profile of health care utilization and expenditures for children with special health care needs.

OBJECTIVES: To provide the first nationally representative data on total health care expenses, out-of-pocket health care expenses, and information on the extent to which out-of-pocket expenses are financially burdensome for families of children with special health care needs (CSHCN). To also compare utilization and expenditure patterns for children with and without special health care needs. DESIGN: We used data from the 2000 Medical Expenditure Panel Survey (MEPS). We present univariate, bivariate, and multivariate statistics on utilization and expenditures adjusted for the complex sample design. PARTICIPANTS: The 2000 MEPS data set contains 6965 children younger than 18 years. Using the CSHCN definition adopted by the federal Maternal and Child Health Bureau and operationalized using the CSHCN Screener, 949 children (15.6%) were identified as children with special health care needs. MAIN OUTCOME MEASURES: Compared with other children, CSHCN had 3 times higher health care expenditures (2099 dollars vs 628 dollars; P<.01). The 15.6% of CSHCN accounted for 42.1% of total medical care costs (excluding dental costs) and 33.6% of total health care costs (including dental costs) attributed to children in 2000. Families of CSHCN were best protected against inpatient hospital care expenses and most exposed to dental care expenses. Families of CSHCN experiencing high out-of-pocket expenses (exceeding 5% of family income) were approximately 11 times more likely to be from households with incomes below 200% of the federal poverty level (odds ratio, 10.9; 95% confidence interval, 3.55-33.76) than to be from families with incomes at or above 400% of the federal poverty level. CONCLUSIONS: Families with CSHCN experience much higher expenditures, including out-of-pocket expenditures, than other children. Insurance plays an important protective role for families of CSHCN, but it still provides incomplete protection. Health policy changes that would extend the breadth and depth of insurance coverage are needed to ensure that all families of CSHCN are protected against burdensome expenses.

Adolescent↗
PubMed2003

Impact of an annual dollar limit or "cap" on prescription drug benefits for Medicare patients.

CONTEXT: Annual dollar limits, or "caps," on drug benefits are common in Medicare managed care (Medicare + Choice) and have been part of several proposals for a national Medicare drug benefit. OBJECTIVES: To determine how cap levels affect the percentage of patients exceeding the cap and their out-of-pocket drug costs and to identify the medications that contribute most to prescription costs. DESIGN AND SETTING: Cross-sectional analysis of 2001 pharmacy claims data from a large Medicare + Choice plan in a mature market with caps of 750 dollars to 2000 dollars per year applied to the plan's share of prescription costs. PARTICIPANTS: Patients who filled at least 1 prescription in 2001 (n = 438 802). MAIN OUTCOME MEASURES: Percentages of patients exceeding caps, identified from prescription claims; out-of-pocket patient costs before exceeding caps, calculated from patients' co-payments; and out-of-pocket patient costs after exceeding caps, estimated from total prescription costs before exceeding the cap. Each unique drug was ranked by total expenditures, which included spending by patients who exceeded caps and by the plan for that drug. RESULTS: A total of 22%, 14%, and 4% of Medicare patients exceeded caps of 750 dollars, 1000 dollars, and 2000 dollars, respectively. Across caps, patients faced a potential 2- to 3-fold increase in median out-of-pocket costs after exceeding caps (179 dollars-305/mo dollars) to continue the same prescription use as before exceeding caps (79-100/mo dollars). For patients who exceeded a cap of 750 dollars, yearly out-of-pocket drug costs ranged from 564 dollars to 4201 dollars (5th-95th percentiles). Fifteen of the 20 medications with the highest total prescription expenditures for patients who exceeded the cap were for chronic conditions. Seven had lower-cost generic versions or a generic medication available in the same treatment class. CONCLUSIONS: At lower caps, a substantial proportion of Medicare patients exceeded their annual drug benefit. To continue the same medication use as before exceeding caps, these patients faced potentially high increases in out-of-pocket costs for medications used primarily to treat chronic conditions. Generic options were not available for many of these drugs.

Aged↗
PubMed2003

Patient-physician communication about out-of-pocket costs.

CONTEXT: Out-of-pocket costs account for approximately one fifth of health care expenditures and are increasing. Previous research suggests that these costs are associated with medication nonadherence and considerable economic burden among some patients. Little is known about patient-physician communication regarding these costs. OBJECTIVE: To identify patients' and physicians' beliefs and practices regarding discussions of out-of-pocket costs. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional paired surveys of 133 general internists and 484 of their outpatients, aged 18 years or older, in 3 academic and 18 community general medicine practices in the Chicago metropolitan area, March-November 2002. MAIN OUTCOME MEASURES: Patient and physician beliefs regarding discussions of out-of-pocket costs, frequency and predictors of discussions, and physician recognition of patient burden from out-of-pocket costs. RESULTS: Sixty-three percent of patients reported a desire to talk with their physician about their out-of-pocket costs, and 79% of physicians believed that patients in general want to discuss these costs. By contrast, only 35% of physicians and 15% of patients reported ever having discussed the study patient's out-of-pocket costs. Multivariate analysis indicated that discussions were significantly more likely to occur with patients burdened by their out-of-pocket costs (prevalence ratio [PR], 2.55; 95% confidence intervals [CI], 1.62-3.76) and with those patients seen in a community practice (PR, 5.19; CI, 1.86-8.93). Among patients burdened by out-of-pocket costs, physicians were substantially more likely to recognize this burden when a prior discussion regarding out-of-pocket costs had taken place (80% vs 51%). CONCLUSIONS: Among respondents, both patients and physicians believed that discussions of out-of-pocket costs were important, yet these discussions occurred infrequently. Physician communication with patients about out-of-pocket costs may be an important yet neglected aspect of current clinical practice. Further research should identify the prevalence of this problem in broader populations, investigate its causes, and evaluate the impact of enhanced communication about out-of-pocket costs on patient satisfaction, utilization of care, and outcomes.

Attitude of Health Personnel↗
PubMedDate not supplied

Willingness to pay and cost of illness for changes in health capital depreciation.

The paper investigates the relationship between the willingness to pay and the cost of illness approach with respect to the evaluation of economic burden due to adverse health effects. The basic intertemporal framework is provided by Grossman's pure investment model, while effects on individual morbidity are taken to be generated by marginal changes in the rate of health capital depreciation. More specifically, both the simple example of purely temporary changes and the more general case of persistent variations in health capital depreciation are discussed. The analysis generates two principal findings. First, for a class of identical individuals cost as measured by the cost of illness approach is demonstrated to provide a lower bound on the true welfare cost to the individual, i.e. cost as given by the willingness to pay approach. Moreover, the cost of illness is increasing in the size of the welfare loss. Second, if one takes into account the possible heterogeneity of individuals, a clear relationship between the cost values supplied by the two approaches no longer exists. As an example, the impact of variations in either financial wealth or health capital endowment is discussed. Thus, diversity in individual type turns out to blur the link between cost of illness and the true economic cost.

Attitude to Health↗
PubMedDate not supplied

Using willingness to pay to assess the benefits of assisted reproductive techniques.

Current economic evaluations of Assisted Reproductive Techniques (ARTs) are criticized for assuming that the only factor important to users is whether they leave the service with a child. Such an approach ignores, first, outcomes beyond some narrow medical definition of success, second, the majority of users who leave the service childless and, third, the actual process of treatment. The aim of this study was to establish the importance of factors beyond some medical definition of success in the provision of ARTs, using the economic instrument of willingness to pay (WTP). The results suggest that there is some value in going through the service, even if the couple leaves it childless. It is concluded that the WTP technique is potentially useful in evaluating ARTs but further studies need to be undertaken to assess its reliability and validity.

Adult↗
PubMedDate not supplied

Using willingness to pay to value close substitutes: carrier screening for cystic fibrosis revisited.

Evidence suggests that previous uses of willingness to pay (WTP) to value close substitutes may have failed to discriminate between the alternatives being evaluated. This paper reports on the application of a new technique for measuring WTP in such contexts. The alternatives evaluated are two methods of screening for cystic fibrosis carrier status. The results suggest that the new method is more discriminating. Furthermore, the paper provides evidence, from reasons for respondents' WTP valuations and regression analyses, that the use of open-ended WTP questions is not valid. This is in line with the recommendations of a recent, influential, report on the use WTP techniques.

Analysis of Variance↗