Copayments for Ambulatory Care: Penny-Wise and Pound-Foolish

Roemer, Milton I.; Hopkins, Carl E.; Carr, Lockwood; Gartside, Foline

doi:10.1097/00005650-197506000-00002

Cited by 75 publications

(33 citation statements)

References 3 publications

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“…Most (22,(31)(32)(33)(34)(35)(36)(37)(38) but not all (39) studies of copayments have observed declines in drug prescriptions ranging from 5% to 10%, even with relatively modest copays. Doubling copayments has reduced antidepressant use by 25% (40).…”

Section: Discussionmentioning

confidence: 99%

The Impact of Cost Sharing on Antidepressant Use Among Older Adults in British Columbia

Wang¹,

Patrick²,

Dormuth³

et al. 2008

Psychiatric Services

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Objective-Antidepressant therapies are underused among older adults and could be further curtailed by patient cost-sharing requirements. The authors studied the effects of two sequential costsharing policies in a large, stable population of all British Columbia seniors: change from full prescription coverage to $10-$25 copayments (copay) in January 2002 and replacement with incomebased deductibles and 25% coinsurance in May 2003.Methods-PharmaNet data were used to calculate monthly dispensing of antidepressants (in imipramine-equivalent milligrams) among all British Columbia residents age 65 and older beginning January 1997 through December 2005. Monthly rates of starting and stopping antidepressants were calculated. Population-level patterns over time were plotted, and the effects of implementing costsharing policies on antidepressant use, initiation, and stopping were examined in segmented linear regression models.Results-Implementation of the copay policy was not associated with significant changes in level of antidepressant dispensing or the rate of dispensing growth. Subsequent implementation of the income-based deductible policy also did not lead to a significant change in dispensing level but led to a significant (p=.02) decrease in the rate of growth of antidepressant dispensing. The copay policy was associated with a significant (p=.01) drop in the frequency of antidepressant initiation among persons with depression. Income-based deductibles reduced the rate of increase in antidepressant This research was presented in a poster session at the 22nd

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Section: Discussionmentioning

confidence: 99%

The Impact of Cost Sharing on Antidepressant Use Among Older Adults in British Columbia

Wang¹,

Patrick²,

Dormuth³

et al. 2008

Psychiatric Services

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“…There is substantial evidence from countries other than Germany that a change in copayments can discourage vulnerable groups from seeking necessary care. In a study described by Roemer et al (1975), only short-term effects could be observed.…”

Section: Copayments For Ambulatory Care In the German Health Care Systemmentioning

confidence: 94%

Copayments for Ambulatory Care in Germany: A Natural Experiment Using a Difference-in-Difference Approach

Schreyögg

Grabka

2008

SSRN Journal

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In response to increasing health expenditures and a high number of physician visits, the German government introduced a copayment for ambulatory care in 2004 for individuals with statutory health insurance (SHI). Because persons with private insurance were exempt from the copayments, this health care reform can be regarded as a natural experiment. We used a difference-in-difference approach to examine whether the new copayment effectively reduced the overall demand for physician visits and to explore whether it acted as a deterrent to vulnerable groups, such as those with low income or chronic conditions. We found that there was no significant reduction in the number of physician visits among SHI members compared to our control group. At the same time, we did not observe a deterrent effect among vulnerable individuals. Thus, the copayment has failed to reduce the demand for physician visits. It is likely that this result is due to the design of the copayment scheme, as the copayment is low and is paid only for the first physician visit per quarter.JEL classification: C13; I18; L31

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“…8 Studies of fixed copayments for prescriptions have reported reductions in overall drug use (e.g., the number of prescriptions filled) of 5 to 10 percent. 7,[9][10][11][12][13] Nonetheless, there are almost no rigorous evaluations of the effect of reference pricing on health care utilization or costs. 14,15 We studied the consequences of reference pricing for angiotensin-converting-enzyme (ACE) inhibitors, a class of antihypertensive medications that are particularly effective in patients with con-gestive heart failure, 16 diabetes, 17 or chronic renal disease.…”

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confidence: 99%