Abstract
BackgroundCost-sharing programs are often too complex to be easily understood by the average insured individual. Consequently, it is often difficult to determine the amount of expenses in advance. This may preclude well-informed decisions of insured individuals to adhere to medical treatment advised by the treating physician. Preliminary research has showed that the uncertainty in these cost-sharing payments are affected by four design characteristics, i.e. 1) type of payments (copayments, coinsurances or deductibles), 2) rate of payments, 3) annual caps on cost-sharing and 4) moment that these payments must be made (directly at point of care or billed afterwards by the insurer).MethodsAn online discrete choice experiment was used to assess the extent to which design characteristics of cost-sharing programs affect the decision of individuals to adhere to recommended care (prescribed medications, ordered diagnostic tests and referrals to medical specialist care). Analyses were performed using mixed multinomial logits.ResultsThe questionnaire was completed by 7921 members of a patient organization. Analyses showed that 1) cost-sharing programs that offer clear information in advance on actual expenses that are billed afterwards, stimulate adherence to care recommended by the treating physician; 2) the relative importance of the design characteristics differed between respondents who reported to have forgone health care due to cost-sharing and those who did not; 3) price-awareness among respondents was limited; 4) the utility derived from attributes and respondents’ characteristics were positively correlated; 5) an optimized cost-sharing program revealed an adherence of more than 72.9% among those who reported to have forgone health care.ConclusionsThe analyses revealed that less complex cost-sharing programs stimulate adherence to recommended care. If these programs are redesigned accordingly, individuals who had reported to have forgone a health service recommended by their treating physician due to cost-sharing, would be more likely to use this service. Such redesigned programs provide a policy option to reduce adverse health effects of cost-sharing in these groups. Considering the upcoming shift from volume-based to value-based health care provision, insights into the characteristics of a cost-sharing program that stimulates the use of recommended care may help to design value-based insurance plans.
Highlights
Cost-sharing programs are often too complex to be understood by the average insured individual
Cost-sharing design characteristics We have examined a number of cost-sharing programs from the perspective of an insured individual to assess which characteristics contribute to their complexity
Of the 7921 included respondents (Table 2), 1048 respondents (13.2%) reported having forgone health care recommended by their treating physician due to cost-sharing payments
Summary
Cost-sharing programs are often too complex to be understood by the average insured individual. It is often difficult to determine the amount of expenses in advance This may preclude well-informed decisions of insured individuals to adhere to medical treatment advised by the treating physician. Policy makers around the world have introduced cost-sharing programs to control rising health care expenditure. These programs introduce financial incentives for insured individuals to increase their awareness of health care costs. Costs have been described as possible reason for not using recommended care [8, 9] It remains unclear which characteristics of a cost-sharing program stimulate the decision of individuals to follow up on recommended care and to what extent
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