Effect Of Cost-sharing Research Articles

Effect of Cost-Sharing on Use of Asthma Medication in Children

To examine the effect of cost-sharing on the use of asthma medications in asthmatic children. According to asthma guidelines, children with asthma may require treatment with multiple medications, including controllers and relievers, to achieve optimal control. Although families may be enrolled in drug benefit plans, impediments to access persist in the form of cost-sharing. Population-based retrospective cohort study of children by analysis of administrative medication insurance claims data. Ontario, Canada. A cohort of 17 046 Ontario children with asthma enrolled in private drug plans. Main Exposure We used data on out-of-pocket expenses and reimbursement for medications to classify children as having zero, low (< 20%), or high (> or = 20%) levels of cost-sharing. We examined use of bronchodilators, inhaled corticosteroids, leukotriene receptor antagonists, oral corticosteroids, and combination agents. Multiple linear and logistic regressions compared medication use between cost-sharing groups, controlling for age and sex. The annual number of asthma medication claims per child was significantly lower in the high cost-sharing group (6.6) compared with the zero (7.0) and low (7.2) cost-sharing groups (P < .001). Children in the high cost-sharing group were less likely to purchase bronchodilators, inhaled corticosteroids, and leukotriene receptor antagonists compared with the low cost-sharing group (odds ratio, 0.76; 95% confidence interval, 0.67-0.86) and were less likely to purchase dual agents compared with the low cost-sharing group (odds ratio, 0.70; 95% confidence interval, 0.66-0.75). The cost-sharing level affected the use of asthma medication, with the highest cost-sharing group exhibiting significantly lower use of maintenance medications and newer dual agents.

Effect of Cost Sharing on Screening Mammography in Medicare Health Plans

Policies that increase patients' share of health care expenses decrease the use of discretionary health services but also may reduce the use of important preventive care such as mammography. We reviewed coverage for mammography within 174 Medicare managed-care plans from 2001 through 2004. Among 550,082 individual-level observations for 366,475 women between the ages of 65 and 69 years, we compared rates of biennial breast-cancer screening in plans requiring cost sharing for mammography with screening rates in plans with full coverage. We also performed a longitudinal analysis of screening rates in plans that changed from full coverage to cost sharing for mammography as compared with rates in matched control plans that did not institute cost sharing. The number of plans with cost sharing for mammography, which we defined as requiring a copayment of more than $10 or coinsurance of more than 10% for screening mammography, increased from 3 in 2001 (representing 0.5% of women) to 21 in 2004 (11.4% of women). Biennial screening rates were 8.3 percentage points lower in cost-sharing plans than in plans with full coverage, a difference that persisted in adjusted analyses (P<0.001). The effect of cost sharing was magnified among women residing in areas of lower income or educational levels (P<0.001 for each interaction). Screening rates decreased by 5.5 percentage points in plans that instituted cost sharing and increased by 3.4 percentage points in matched control plans that retained full coverage (P<0.001 for the adjusted analysis). Relatively small copayments were associated with significantly lower mammography rates among women who should undergo screening mammography according to accepted clinical guidelines. For effective preventive services such as mammography, exempting elderly adults from cost sharing may be warranted.

Effect of Cost-Sharing for Prescription Medications on Health Outcomes in Older Adults: A Critical Review of the Literature and Potential Implications for Managed Care

To review the literature addressing the relationship between increased cost-sharing of prescription medications within a managed care setting and health outcomes in older adults. A Medline/preMedline search (1950 to August 21, 2007) was conducted to identify pertinent peer-review studies with robust study designs specifically addressing cost-sharing of prescription medications and health outcomes. Studies were selected if they were conducted within a managed care environment, evaluated prescription medications, provided specifics regarding health outcomes, and did not focus on a solitary chronic disease state or medication class. Studies had to employ study designs with claims-based data sources in which cross-sectional or longitudinal variation in amount of co-payments or coinsurance occurred. From 61 articles, seven studies were selected, five addressing beneficiaries > or =65 years of age and two addressing those <65 years of age. Increases in cost-sharing in managed care organizations, particularly for the elderly, can result in greater use of health care services (e.g., emergency department visits and hospital admissions), with a possible increase in mortality. Based on the limited number of studies published, increased cost-sharing of prescription medications for elderly beneficiaries appears to exert negative effects on health outcomes and may be related to an increase in utilization of other health care services. If managed care organizations continue with their current policy of multi-tiered increases, the future may remain bleak for both the managed care organizations and their geriatric beneficiaries.

Finding the Efficient Frontier of a Bi-Criteria, Spatially Explicit, Harvest Scheduling Problem

Abstract The effects of cost-sharing and information assistance on nonindustrial private forest owners’ investment in timber stand improvements are analyzed using a two-step estimation method. We use survey data on Finnish nonindustrial private forestland owners’ stand improvements in 1994–1998, including precommercial thinnings, cleaning of seedling stands, and restoration thinnings of juvenile stands. The investment decision is theoretically considered in a two-period model with amenity values. To allow for the joint determination of participation in the cost-sharing program and the decision to invest, a two-step estimation method is used. The predicted probability of using public subsidy from the first-step model is included in the second-step model for the probability or relative extent of stand improvements. For robust inference, quasi-maximum likelihood estimation is applied. Public subsidy, personal assistance, and forest planning expectedly increased the probability of investing. Public subsidy especially had substantial effects on the probability and extent of stand improvements. Besides overcoming the endogeneity of cost-sharing, the two-step approach showed that personal assistance also encourages stand improvements indirectly through its effect on the use of public subsidy.

Cost-Sharing and Private Timber Stand Improvements: A Two-Step Estimation Approach

Abstract The effects of cost-sharing and information assistance on nonindustrial private forest owners’ investment in timber stand improvements are analyzed using a two-step estimation method. We use survey data on Finnish nonindustrial private forestland owners’ stand improvements in 1994–1998, including precommercial thinnings, cleaning of seedling stands, and restoration thinnings of juvenile stands. The investment decision is theoretically considered in a two-period model with amenity values. To allow for the joint determination of participation in the cost-sharing program and the decision to invest, a two-step estimation method is used. The predicted probability of using public subsidy from the first-step model is included in the second-step model for the probability or relative extent of stand improvements. For robust inference, quasi-maximum likelihood estimation is applied. Public subsidy, personal assistance, and forest planning expectedly increased the probability of investing. Public subsidy especially had substantial effects on the probability and extent of stand improvements. Besides overcoming the endogeneity of cost-sharing, the two-step approach showed that personal assistance also encourages stand improvements indirectly through its effect on the use of public subsidy.

Congestible communications networks and international trade

We build a two‐country model of monopolistic competition with communications networks. A communications network is characterized by (1) the existence of large fixed costs of network provision, and (2) the presence of congestion. It is demonstrated that both the size of a country and the relative magnitude of the congestion effect determine its comparative advantage: if the congestion effect (resp., the cost‐sharing effect) prevails universally, a comparative advantage in the goods that require communications is held by the smaller (resp., larger) of the two countries. JEL Classification: D43, F12 Réseaux de communication, congestion et commerce international. Ce mémoire présente un modèle de concurrence monopolistique à deux pays avec des réseaux de communication. Un réseau de communication est caractérisé par (1) l’existence de coûts fixes importants pour la mise en place du réseau et (2) la présence de congestion. On montre que la taille du pays et la magnitude relative de la congestion déterminent l’avantage comparatif : si l’effet de congestion (ou respectivement l’effet de partage des coûts) prévaut, un avantage comparatif dans les biens qui demandent plus de communication est détenu par le plus grand (respectivement le plus petit) des deux pays.

Congestible communications networks and international trade

We build a two-country model of monopolistic competition with communications networks. A communications network is characterized by (1) the existence of large fixed costs of network provision, and (2) the presence of congestion. It is demonstrated that both the size of a country and the relative magnitude of the congestion effect determine its comparative advantage: if the congestion effect (resp., the cost-sharing effect) prevails universally, a comparative advantage in the goods that require communications is held by the smaller (resp., larger) of the two countries.

Utilisation of dental services in Tanzania before and after the introduction of cost-sharing

The objective of this study was to evaluate the effect of cost-sharing, introduced in July 1994, on the utilisation of dental services in Tanzania. The study compared dental attendance, demand for dental services and treatment pattern of patients in 17 out of 20 regions of mainland Tanzania in 1993 and 1995, a year before and after the introduction of user fees. Dental attendance and demand for treatment. Results revealed a 33.2 per cent overall reduction in dental attendance but no effect on either the demand for treatment or treatment pattern. The exceptions were increases in referral cases by 14.5 times and prosthetic work by 3.9 times, and a reduction in surgical cases by 18.8 per cent. In order to improve attendance and decrease referrals it is necessary to enforce the first line of oral primary health care to meet the simple treatment demands. Furthermore, the revenue generated by cost-sharing should be used to improve services.

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.

Health insurance: The tradeoff between risk pooling and moral hazard

Choosing optimal health insurance coverage involves a trade-off between the gain from risk reduction and the deadweight loss from moral hazard. This paper examines this trade-off empirically by estimating both the demand for health insurance and the demand for health services. It relies on data from a randomized controlled trial of cost-sharing's effects on the use of health services and on the health status for a general, non-elderly population.

Assessment of the Effects of Cost-Sharing in Yugoslavia

In this study the existing forms and amounts of cost-sharing in the Republic of Serbia (Yugoslavia) are analyzed. The level of cost-sharing is ranked according to the number and type of services involved and the relative importance with which they are viewed within the overall health-care policy of Yugoslavia. The "self-managing community of interest of health care," administratively coincident with the district, is taken as the unit of observation. Until recently, these bodies independently decided whether to introduce cost-sharing as well as the rate of cost-sharing. Therefore, the implementation of this health-policy measure differed among the districts generating inequality within health-care system. The results of simple and multiple correlation indicate that poorer districts with fewer health resources and lower levels of consumption introduced cost-sharing for more services, attempting to provide additional resources for financing of the health-care system. The multiple linear-regression model shows that population/physician ratio and the use of primary care physicians' services are the significant indicators of health-care expenditures in this territory. Considering the current economic situation in Yugoslavia and the level of development of the health-care system, the results of this cross-sectional study imply that cost-containment in health care can be achieved in a more equitable and effective manner by controlling supply of health services than by limiting demands.

Effect of Cost-sharing on Use of Medically Effective and Less Effective Care

Effect of Cost-sharing on Use of Medically Effective and Less Effective Care

Effect of Cost-sharing on the Probability of Episodes of Care for Specific Diseases

Effect of Cost-sharing on the Probability of Episodes of Care for Specific Diseases

Cost-sharing and provider choice

Restoring financial incentives to encourage patients to shop for the lowest prices for medical care underlies current procompetitive health financing proposals. This paper analyzes the impact of one such financial incentive - cost-sharing in health insurance - on patients' provider shopping behavior. Using data from the ‘Health Insurance Study’, the relationship of cost- sharing with the specialty type of the primary care provider and with the costliness of the selected provider is investigated. The results were mixed as to whether patients who have only catastrophic coverage seek lower priced physicians than patients who have free care; however, any differences were small. Even among the well-educated, who are likely to be more efficient than the less educated at obtaining comparative price information, the effects of cost-sharing on the costliness of the selected medical care provider were minimal.

Effect of Cost-Sharing on the Use of Medical Services by Children: Interim Results from a Randomized Controlled Trial

Health care expenditures of 1,136 children whose families participated in a randomized trial, The Rand Health Insurance Experiment, are reported. Children whose families were assigned to receive 100% reimbursement for health costs spent one third more per capita than children whose families paid 95% of medical expenses up to a family maximum. Outpatient use decreased as cost-sharing rose for a variety of use measures: the probability of seeing a doctor, annual expenditures, number of visits per year, and numbers of outpatient treatment episodes. Hospital expenditures did not vary significantly among children insured with varying levels of cost-sharing. Episodes of treatment for preventive care were as responsive to cost-sharing as episodes for acute or chronic illness. The results give no reason not to insure preventive care as liberally as care for acute illness.

Effects of cost-sharing on users of a state's health service program.

This study analyzed some of the effects of the introduction of cost-sharing on users of the state's health service program. The study population had previously received services at no charge and consisted of people with provider-determined medical need, and included, but was not limited to people in financial need. The study sample was selected from 3 years of program service records (1977-1980). Sampling was random and stratified by key variables. Time-series analysis as well as pre/post-policy comparisons were employed. Analysis of changes in the distributions of service user characteristics and in services provided indicated that use of services was not affected adversely and that lower-income, medically needy people were not deterred from using services following the introduction of cost-sharing. Limitations to the study are reviewed, and implications of using cost-sharing in programs such as Medicaid are considered.

Cost-sharing effects--response to Myers.

Wolfson, Jay Dr. P.H.*; Sear, Alan M. Ph.D.†; Kapadia, Asha S. Ph.D.‡; Decker, Michael Ph.D.‡; Roht, Lewis M.D.‡ Author Information