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Does patient cost sharing lead to better care?(Pro & Con)
YES Consumer cost sharing is by no means a preferred tool by which to optimize the value of health spending.
A better approach would be to rely primarily on clinicians and hospitals. However, the triad of professionalism, government regulation, and managed care insurers has proved insufficient to achieve consistent delivery of high quality, cost-effective care, as articulated by the Institute of Medicine in its "Crossing the Quality Chasm" report.
If we use cost sharing, it should be supplemented with provider payment reforms. In addition, we should tailor it to promoting high quality of care at the most affordable total cost of services, rather than use it as a blunt instrument. The lessons of the research literature are dear that increasing cost-sharing without giving consumers guidance on which providers and treatment options offer superior quality and efficiency is futile; most consumers are unable to distinguish ineffective or inefficient services from effective, efficient services.
The method most likely to optimize consumers' value from health care spending requires calibrating increased consumer out-of-pocket cost to the incremental cost incurred by their insurance pool when a consumer selects a less efficient pathway to high quality. The latter is shown by selection of a brand drug when a lower-cost generic is available. For equity to be ensured, maximum consumer out-of-pocket spending limits should be geared to consumer income levels.
Such tailored cost-sharing solutions would also enable lower consumer cost sharing when consumers select providers or treatment options that constitute the most efficient pathway to high quality.
An example of this type of patient cost sharing is the use of tiered consumer co-payments based on the efficiency and quality of the providers, the treatments they select, and whether a consumer participates in an individualized health risk reduction program. Under such cost sharing, consumers aren't forced to research the quality and efficiency ratings relevant to each selection that they make; rather, differences in quality and efficiency ratings between options are "baked into" differences in the level of cost sharing.
These solutions aim at encouraging consumers to be better stewards of the "commons" of their health insurance pools, improving health insurance affordability, and promoting quality ...
- HIRC's drug copay service shows trend toward increased patient cost-sharing.
- Newspaper article from: Health & Medicine Week June 28, 2004 700+ words
...the "Spring 2004 Drug Copay Service" shows that a dominant trend in drug benefits today is toward increased patient cost-sharing. "Health plans, PBMs, and large employers are raising fixed tier and percentage copays and increasing their...
- HIRC's Drug Copay Service Shows Trend Toward Increased Patient Cost-Sharing.
- Press release article from: Business Wire June 2, 2004 700+ words
...therapies, the Spring 2004 Drug Copay Service shows that a dominant trend in drug benefits today is toward increased patient cost-sharing. "Health plans, PBMs, and large employers are raising fixed tier and percentage copays and increasing their...
- Physician response to the United Mine Workers' cost-sharing program: the other...
- Magazine article from: Health Services Research Fahs, Marianne C. April 1, 1992 700+ words
...medical care. Increased patient cost sharing continues to be offered as...addressed the implications of patient cost sharing for physician treatment patterns...policy problems. Increased patient cost sharing has gained acceptance among...
- The impact of increasing patient prescription drug cost sharing on therapeutic...
- Magazine article from: Health Services Research Johnson, Richard E. Goodman, Michael J. Hornbrook, Mark C. Eldredge, Michael B. April 1, 1997 700+ words
...prescription drug costs is patient cost sharing. This approach shifts a...patient. Mechanisms for patient cost sharing include deductibles, coinsurance...and the introduction of patient cost sharing will reduce or eliminate...
- Experts ponder limitations of cost-sharing.
- Magazine article from: Employee Benefit News Elswick, Jill February 1, 2004 700+ words
...and $3,768, respectively. Cost-sharing disproportionately affects low...called the "blunt instrument" of cost-sharing, Sally Trude, senior health...December 2003 issue brief, "Patient Cost Sharing: How Much is Too Much?" posits...
- The Direct and Indirect Effects of Cost-Sharing on the Use of Preventive...
- Magazine article from: Health Services Research Solanki, Geetesh Schauffler, Helen Halpin Miller, Leonard S. February 1, 2000 700+ words
...employee out-of-pocket patient cost-sharing for 52 different health plans...the demonstrated impact of cost-sharing on the use of curative and...Understanding the effects of patient cost-sharing on the use of preventive services...
- Value and increased cost sharing in the American health care system.(Editorial)
- Magazine article from: Health Services Research Chernew, Michael Fendrick, A. Mark April 1, 2008 700+ words
...manifested in the move toward higher patient cost sharing at the point of service. In...suggests that, when faced with cost sharing consumers reduce consumption...Chernew 2007). VBID argues that patient cost sharing should be set based on the...
- Cost Sharing
- Encyclopedia entry from: Encyclopedia of Small Business January 1, 2007 700+ words
Cost Sharing Cost sharing is a process wherein two or more entities work together to secure...many small business enterprises with limited financial resources. Cost sharing partnerships can be entered into by a business with other businesses...
Source: HighBeam Research, Does patient cost sharing lead to better care?(Pro & Con)