Coalition provides small business clout to cap costs, share corporate costs.
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Arizona↗
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Results for “Cost Sharing”
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Health status and heterogeneity of cost-sharing responsiveness: how do sick people respond to cost-sharing?
This paper examines whether the responsiveness of health care utilization to cost-sharing varies by health status and the implications of such heterogeneity. First, we show theoretically that if health care utilization of those in poor health is less responsive to cost sharing, this, combined with the skewness of health expenditures in health status, leads to overestimates of the effect of cost sharing. This bias is exacerbated when elasticities are generalized to populations with greater expenditure skewness. Second, we show empirically that cost-sharing responsiveness does differ by health status using data from the Medicare Current Beneficiary Survey. Medicare beneficiaries are stratified into health status groups based on activity of daily living (ADL) impairments and self-reported health status. Separately, for each of the health status groups, we estimate the effect of Medigap insurance on Part B utilization using a two-part expenditure model. We find that the change in expenditures associated with Medigap is smaller for those in poorer health. For example, when stratified using ADLs, Medigap insurance increases expenditures for 'healthy' groups by 36.4%, while the increase for the 'sick' group is 12.7%. Results are qualitatively the same for different forms of supplemental insurance and different methods of health status stratification. We develop a test to demonstrate that adjusting our results for selection bias would result in estimates of greater heterogeneity. Our results imply that a lowerbound estimate of the bias from neglecting heterogeneity is about 2-7%.
Activities of Daily Living↗
Cost-sharing for prescriptions of sildenafil and finasteride: a case study in veteran patients.
OBJECTIVE: To evaluate patients willingness to share the costs of 2 medications (often described as "lifestyle medications"): sildenafil for erectile dysfunction and finasteride for hair loss, which are not routinely covered by the Department of Veterans Affairs (VA) healthcare system. STUDY DESIGN: Self-administered, anonymous survey. PATIENTS AND METHODS: Adult men (n = 339) were recruited from waiting rooms for primary care or erectile dysfunction clinic appointments at 2 Los Angeles VA facilities. RESULTS: Participants with self-reported need were analyzed separately for finasteride (primary care patients only) and sildenafil (both primary care and erectile dysfunction clinic patients). The mean age of the participants was 56 and 60 years for the finasteride and sildenafil groups, respectively. Mean annual household income for both groups was under $10,000. Respondents reported a mean willingness to cost-share $4.20 for a 30-day prescription of daily finasteride (VA wholesale cost = $27) and $5.40 for 4 sildenafil pills (VA wholesale cost = $20). In the multivariate analysis, higher income (P = .002) and increasing self-reported need for medication (P = .04) were associated with increased willingness to cost-share for finasteride after controlling for age, race/ethnicity, insured status, comorbid conditions, and type of clinic. In addition, younger age (P = .01) was associated with greater willingness to cost-share for sildenafil. CONCLUSIONS: In this low-income veteran population, patients with a self-reported need for sildenafil and finasteride would be willing to make a higher copayment than the current VA maximum copayment of $2.00 per 30-day prescription, if these medicines were made available.
Adult↗
Managed care outlook. Similarity seen in prescription cost-sharing.
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Cost Sharing↗
The implications of cost sharing.
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Cost Sharing↗
Xerox utilization falls with increased cost sharing.
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Costs and Cost Analysis↗
How low can you go? The impact of reduced benefits and increased cost sharing.
Amid escalating health care costs and a managed care backlash, employers are considering traditional cost control methods from the pre-managed care era. We use an actuarial model to estimate the premium-reducing effects of two such methods: increasing employee cost sharing and reducing benefits. Starting from a baseline plan with rich benefits and low cost sharing, estimated premium savings as a result of eliminating five specific benefits were about 22 percent. The same level of savings was also achieved by increasing cost sharing from a 15 dollars copayment with no deductible to 20 percent coinsurance and a 250 dollars deductible. Further increases in cost sharing produced estimated savings of up to 50 percent. We discuss possible market- and individual-level effects of the proliferation of plans with high cost sharing and low benefits.
Actuarial Analysis↗
Prescription cost sharing: economic and health impacts, and implications for health policy.
Cost sharing for prescription pharmaceuticals--in the form of copayments, coinsurance, or deductibles--is now common in healthcare systems throughout the world. Although there are no studies that directly or convincingly measure the effects of prescription cost sharing on health status or treatment outcomes, cost sharing does appear to reduce utilisation of pharmaceuticals; however, more information is required concerning the relationship between cost sharing and prescription-filling behaviour. Additionally, outcomes studies are needed to define appropriate and inappropriate cost-sharing levels for particular groups of patients, based on income, disease, employment status, and other factors. Cost sharing for pharmaceuticals and other medical services is likely to increase in the near future. As a result, consumers will have a greater role in treatment decisions and will also become more interested in knowing the value of the medicines they are asked to purchase. They are therefore likely to demand pharmaceutical products that are more cost-effective and products that improve quality of life. The increased implementation of cost-sharing programmes necessitates the adoption of appropriate cost-sharing policies, which incorporate the following general principles: 1. Consumers must be provided with the information required to make informed decisions, including the value of the medication, its importance in the treatment plan, and the consequences of not having the prescription filled. 2. Aggressive or abusive cost-sharing features that deny access to optimal pharmaceutical therapy must be avoided. 3. Inappropriate cost sharing, either fixed level or percentage of the prescription cost, may affect disease control and ultimately health or functional status. 4. Cost sharing restricted to pharmaceuticals may encourage replacement of drug therapy with more expensive forms of treatment; therefore, cost sharing should apply to the full range of medical services to prevent service substitution.
Aged↗
An update on physician practice cost shares.
The 1988 physicians' practice costs and income survey (PPCIS) collected detailed costs, revenues, and incomes data for a sample of 3,086 physicians. These data are utilized to update the Health Care Financing Administration (HCFA) cost shares used in calculating the medicare economic index (MEI) and the geographic practice cost index (GPCI). Cost shares were calculated for the national sample, for 16 specialty groupings, for urban and rural areas, and for 9 census divisions. Although statistical tests reveal that cost shares differ across specialties and geographic areas, sensitivity analysis shows that these differences are small enough to have trivial effects in computing the MEI and GPCI. These results may inform policymakers on one aspect of the larger issue of whether physician payments should vary by geographic location or specialty.
Analysis of Variance↗
A framework for cost-sharing policy analysis.
To assess the effect of cost sharing, a framework for describing and evaluating cost-sharing programmes was constructed, followed by a comprehensive search of the international literature on the subject. The results indicated that cost sharing carries many potential advantages, one of which includes increased consumer attention to healthcare costs. However, proper design of cost-sharing programmes is necessary to mitigate regressivity and other common problems associated with many current programmes. These findings should help policy makers to understand and anticipate the effects of cost sharing, and to create innovative benefit design solutions that are targeted to promote health system goals.
Cost Sharing↗
Changes in drug utilization following the outpatient prescription drug cost-sharing program--evidence from Taiwan's elderly.
This paper examines changes in drug utilization following Taiwan's newly implemented National Health Insurance (NHI) outpatient prescription drug cost-sharing program for persons over 65 years old. The study is a hospital outpatient prescription level analysis that adopts a pretest-posttest control group experiment design. Selected measures of outpatient prescription drug utilization are examined for cost-sharing and non cost-sharing groups in cost-sharing periods and pre cost-sharing periods. Additional analyses were conducted comparing older patients with and without chronic diseases and differences for essential and non-essential drugs. Patients over age 65 were drawn from 21 hospitals in the Taipei area using a stratified random sampling method. This paper yields several interesting findings. First, average prescription cost and prescription period increased for both the cost-sharing and non cost-sharing groups. However, the rate of increase was significantly less in the cost-sharing group when compared with the non cost-sharing group. Second, the elderly with non-chronic diseases were more sensitive (i.e., reducing drug utilization) to the drug cost-sharing program when compared with those with chronic diseases. Third, for the elderly with non-chronic diseases average drug cost per prescription experienced a smaller decrease in essential drugs but a moderate increase in non-essential drugs for the cost-sharing group. By contrast, for the non cost-sharing group, average drug cost per prescription increased sharply in non-essential drugs as well as essential drugs. Finally, there was a significant increase in the number of prescriptions as well as drug costs above the upper bound of the cost-sharing schedule. The outpatient drug cost-sharing program implemented by the NHI in Taiwan did not reverse the trend of prescription drug cost increases in hospitals. The significant increase in the number of prescriptions above the upper bound of the cost-sharing schedule implies that the NHI should increase the upper bound. Further analysis needs to evaluate any adverse clinical impact for older patients resulting from policy changes.
Aged↗
Physician response to the United Mine Workers' cost-sharing program: the other side of the coin.
The effect of cost sharing on health services utilization is analyzed from a new perspective, that is, its effects on physician response to cost sharing. A primary data set was constructed using medical records and billing files from a large multispecialty group practice during the three-year period surrounding the introduction of cost sharing to the United Mine Workers Health and Retirement Fund. This same group practice also served an equally large number of patients covered by United Steelworkers' health benefit plans, for which similar utilization data were available. The questions addressed in this interinsurer study are: (1) to what extent does a physician's treatment of medically similar cases vary, following a drop in patient visits as a result of cost sharing? and (2) what is the impact, if any, on costs of care for other patients in the practice (e.g., "spillover effects" such as cost shifting)? Answers to these kinds of questions are necessary to predict the effects of cost sharing on overall health care costs. A fixed-effects model of physician service use was applied to data on episodes of treatment for all patients in a private group practice. This shows that the introduction of cost sharing to some patients in a practice does, in fact, increase the treatment costs to other patients in the same practice who remain under stable insurance plans. The analysis demonstrates that when the economic effects of cost sharing on physician service use are analyzed for all patients within a physician practice, the findings are remarkably different from those of an analysis limited to those patients directly affected by cost sharing.
Cost Sharing↗
Adverse events associated with prescription drug cost-sharing among poor and elderly persons.
CONTEXT: Rising costs of medications and inequities in access have sparked calls for drug policy reform in the United States and Canada. Control of drug expenditures by prescription cost-sharing for elderly persons and poor persons is a contentious issue because little is known about the health impact in these subgroups. OBJECTIVES: To determine (1) the impact of introducing prescription drug cost-sharing on use of essential and less essential drugs among elderly persons and welfare recipients and (2) rates of emergency department (ED) visits and serious adverse events associated with reductions in drug use before and after policy implementation. DESIGN AND SETTING: Interrupted time-series analysis of data from 32 months before and 17 months after introduction of a prescription coinsurance and deductible cost-sharing policy in Quebec in 1996. Separate 10-month prepolicy control and postpolicy cohort studies were conducted to estimate the impact of the drug reform on adverse events. PARTICIPANTS: A random sample of 93 950 elderly persons and 55 333 adult welfare medication recipients. MAIN OUTCOME MEASURES: Mean daily number of essential and less essential drugs used per month, ED visits, and serious adverse events (hospitalization, nursing home admission, and mortality) before and after policy introduction. RESULTS: After cost-sharing was introduced, use of essential drugs decreased by 9.12% (95% confidence interval [CI], 8.7%-9.6%) in elderly persons and by 14.42% (95% CI, 13.3%-15.6%) in welfare recipients; use of less essential drugs decreased by 15.14% (95% CI, 14.4%-15.9%) and 22.39% (95% CI, 20.9%-23.9%), respectively. The rate (per 10 000 person-months) of serious adverse events associated with reductions in use of essential drugs increased from 5.8 in the prepolicy control cohort to 12.6 in the postpolicy cohort in elderly persons (a net increase of 6.8 [95% CI, 5.6-8.0]) and from 14.7 to 27.6 in welfare recipients (a net increase of 12.9 [95% CI, 10.2-15.5]). Emergency department visit rates related to reductions in the use of essential drugs also increased by 14.2 (95% CI, 8.5-19.9) per 10 000 person-months in elderly persons (prepolicy control cohort, 32.9; postpolicy cohort, 47.1) and by 54.2 (95% CI, 33.5-74.8) among welfare recipients (prepolicy control cohort, 69.6; postpolicy cohort, 123.8). These increases were primarily due to an increase in the proportion of recipients who reduced their use of essential drugs. Reductions in the use of less essential drugs were not associated with an increase in risk of adverse events or ED visits. CONCLUSIONS: In our study, increased cost-sharing for prescription drugs in elderly persons and welfare recipients was followed by reductions in use of essential drugs and a higher rate of serious adverse events and ED visits associated with these reductions.
Adult↗
All rights reserved, or can we just copy? Cost sharing arrangements and characteristics of health care systems.
In most European countries cost sharing has been introduced in order to reduce the demand for care. Different forms of cost sharing are available, but because of historically grown system characteristics and prevailing values countries differ in the application of specific forms. This review focuses on eighteen European countries, and on the combinations of health system characteristics and present forms of cost sharing. We found that some combinations are more present: different payment systems for primary care physicians go together with different forms of cost sharing, different services have different forms of cost sharing. In countries with a GP as gatekeeper no charges are in use for the GP. No distinct relationship could be found between the financing system (tax-based or insurance-based) and the form of cost sharing or the exclusion of vulnerable populations. It is concluded that there are two ways of filtering 'unnecessary' demand. One is by introducing cost sharing for directly accessible services such as GPs. The second way is by having GPs act as gatekeepers to more specialized, and more costly care.
Cost Sharing↗
The effects of patient cost sharing on ambulatory utilization in South Korea.
This study focused mainly on the effects of patient cost sharing on the demand for physician service, especially in the low-income people. Patient cost sharing is one of the policies used extensively in the health care financing in Korea, which has been adopted to control the health care cost. It has raised the argument that cost sharing inhibits low-income patients' access to affordable medical care. Data from the National Health and Nutrition Survey conducted 1998 by the Korean Ministry of Health and Welfare was used for this analysis. Multiple regression was done with the dependent variable of the amount of ambulatory utilization and price elasticities are estimated. We obtained significant out-of-pocket price elasticities depending on patient income levels and types of care facilities in the range of -0.21 to -0.07, -0.20 to -0.10, respectively. We found out that low-income patients are more sensitive to cost sharing than high-income patients. Furthermore, we found out that the users of general hospitals are less sensitive to cost sharing than the users of clinics. These results shows that the cost sharing policy in Korea does not efficiently work. Patient cost sharing in Korea induces inequitable medical service utilization and also it does not decrease moral hazard in the sense that the higher cost-sharing sector is less sensitive to cost sharing.
Adult↗
The demand for prescription drugs as a function of cost-sharing.
This paper estimates how cost-sharing affects the use of prescription drugs. The data for this analysis are derived from the Rand Health Insurance Experiment (HIE), a randomized controlled trial that randomly assigned participants to insurance plans with varying coinsurance rates and deductibles. Therefore, the cost-sharing they faced was independent of their health and demographic characteristics. The paper used HIE data from four sites to estimate how drug expenditures vary by insurance plan, and to compare the plan response for drugs with that for all ambulatory expenses. The findings show that: (1) individuals with more generous insurance buy more prescription drugs; (2) the cost-sharing response for drugs is similar to the response for all ambulatory medical services; (3) the Dayton, Ohio site had significantly greater drug expenditures per capita than the other sites studied and a significantly higher proportion of drugs sold by physicians; and (4) the proportion of brand-name drugs among all drugs purchased in pharmacies was not a function of insurance plan. In the Dayton, Ohio site, a significantly higher proportion of the drugs purchased in pharmacies were brand-name rather than generic.
Deductibles and Coinsurance↗
Cost-sharing and the utilization of clinical preventive services.
BACKGROUND: Little is known about the effect of different forms of patient cost-sharing on the utilization of clinical preventive services or if the effect varies by type of health plan. OBJECTIVES: To assess empirically the relationships between the utilization of recommended preventive services and different forms of patient cost-sharing and how the effect is mediated by type of preventive service (counseling, blood pressure, Pap smear, mammogram), type of cost-sharing (deductibles/coinsurance, copayments), and type of health plan (HMO, PPO/indemnity plan). RESEARCH DESIGN: Sixteen logit models were estimated to assess variation in receiving recommended preventive care as a function of cost-sharing within plan type. SUBJECTS: A sample of 10,872 employees, aged 18 to 64 years, of seven large companies served by 52 health plans with diverse cost-sharing arrangements who responded to the Pacific Business Group on Health, Health Plan Value Check Survey (response rate, 50.3%). MEASURES: Receipt of recommended preventive care was based on the U.S. Preventive Services Task Force Guidelines. The effect of cost-sharing was measured as the percentage change in the probability of receiving recommended preventive care in the cost-sharing group compared to the non cost-sharing group. RESULTS: The negative effect of patient cost-sharing was greatest on preventive counseling in PPO/indemnity plans (-15%) and on mammograms in all health plan types (-9%-10%). The effect on Pap smears was negative (-8%-10%) for deductibles/coinsurance in PPO/indemnity plans and copayments in HMOs. The effect of cost-sharing on blood pressure was mixed. Deductibles/coinsurance had a greater negative effect than copayments. CONCLUSIONS: Eliminating patient cost-sharing for selected preventive services may be a relatively easy and effective means of increasing utilization of recommended clinical preventive care.
Adolescent↗
The effects of prescription drug cost sharing: a review of the evidence.
OBJECTIVES: To determine whether patients respond to increased cost sharing by substituting less expensive alternatives for medications with higher levels of copayments or coinsurance, and to examine the body of evidence on the relationships between cost sharing and use of essential or maintenance medications, health outcomes, process-of-care measures (such as medication adherence and discontinuation), and costs. STUDY DESIGN: Literature review. METHODS: Healthcare reference databases and key journals were searched to identify peer-reviewed empirical studies that examined the effects of variation in the amount of prescription drug copayments or coinsurance on healthcare utilization patterns. Thirty studies met our search criteria. RESULTS: Higher levels of prescription drug cost sharing generally produce intended effects, namely, decreasing the consumption of prescription drugs and steering patients away from nonpreferred to preferred brand-name drugs. However, patients do not always switch to generic drugs. Although not consistently reported, the most troublesome effects associated with higher levels of cost sharing are treatment disruptions (such as lower levels of treatment adherence, continuation, and initiation) for chronically ill patients. At times, higher levels of cost sharing can affect the use of essential medications and outcomes of care. CONCLUSIONS: Cost sharing reduces the consumption of prescription drugs but may have unintended effects on the process and outcomes of therapy. Further research is warranted in this area. The central question for health plan managers and policy makers is whether we will continue to use cost sharing as is or make modifications to reduce unintended effects.
Choice Behavior↗