Cost-Sharing: A Blunt Instrument

Remler, Dahlia K.; Greene, Jessica

doi:10.1146/annurev.publhealth.29.020907.090804

Cited by 62 publications

(79 citation statements)

References 51 publications

(67 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our finding that a substantially higher proportion of patients with these plans The Emergency Severity Index is a validated measure of severity of illness at the time of presentation to an emergency department, and is used to stratify patients into five groups (Level 1 = most severe; Level 5 = least severe) for triage priority experienced cost-related barriers to filling prescriptions than did privately insured patients is likely due to the finding of numerous prior studies that cost sharing at even very low levels impedes access to care for low-income patients. [18][19][20][21][22] A different explanation may hold for our finding that more patients with Medicaid and Commonwealth Care Type 1 than with private insurance reported delaying or not getting dental care due to cost, as these publicly subsidized plans cover basic preventive dental services, but not more extensive dental work. Our finding that Medicaid patients also reported cost-related For patients with Commonwealth Care Type 2 and 3 plans, cost sharing can be more substantial and indeed, we found cost-related barriers to care for services where cost sharing was particularly high.…”

Section: Discussionmentioning

confidence: 99%

Access to Care After Massachusetts’ Health Care Reform: A Safety Net Hospital Patient Survey

et al. 2012

View full text Add to dashboard Cite

Patients with Commonwealth Care and Medicaid, the two forms of insurance most often newlyacquired under the reform, reported similar or higher utilization of and access to outpatient visits and rates of having a usual source of care, compared with the privately insured. Compared with the privately insured, a significantly higher proportion of patients with Medicaid or Commonwealth Care Type 1 (minimal cost sharing) reported delaying or not getting dental care (42.2 % vs. 27.1 %) or medication (30.0 % vs. 7.0 %) due to cost; those with Medicaid also experienced costrelated barriers to seeing a specialist (14.6 % vs. 3.5 %) or getting recommended tests (15.6 % vs. 5.9 %). Those with Commonwealth Care Types 2 and 3 (greater cost sharing) reported significantly more costrelated barriers to obtaining care than the privately insured (45.0 % vs. 16.0 %), to seeing a primary care doctor (25.0 % vs. 6.0 %) or dental provider (58.3 % vs. 27.1 %), and to obtaining medication (20.8 % vs. 7.0 %). No differences in cost-related barriers to preventive care were found between the privately and publicly insured.CONCLUSIONS: Access to care improved less than access to insurance following Massachusetts' health care reform. Many newly insured residents obtained Medicaid or state subsidized private insurance; costrelated barriers to access were worse for these patients than for the privately insured.KEY WORDS: access to care; health insurance; health disparities; health care reform; health care policy.

show abstract

Section: Discussionmentioning

confidence: 99%

Access to Care After Massachusetts’ Health Care Reform: A Safety Net Hospital Patient Survey

et al. 2012

View full text Add to dashboard Cite

show abstract

“…19 Again, these findings are consistent with international evidence. 20,21 Gap payments and PBS co-payments impact most significantly on the poor -those who are most likely to suffer ill health in the first place. [5][6][7][8]22 The empirical evidence evaluating the effect of co-payment on healthcare demand clearly identifies that individuals with lower incomes reduce their use of healthcare services to a greater extent in response to increased copayments.…”

Section: What Out-of-pocket Expenditures Do Australian Health Consumementioning

confidence: 99%

Co-payments for health care: what is their real cost?

Laba

Usherwood

Leeder

et al. 2015

Aust. Health Review

View full text Add to dashboard Cite

Abstract. Based on the premise that current trends in healthcare spending are unsustainable, the Australian Government has proposed in the recent Budget the introduction of a compulsory $7 co-payment to visit a General Practitioner (GP), alongside increased medication copayments. This paper is based on a recent submission to the Senate Inquiry into the impact of out-of-pocket costs in Australia. It is based on a growing body of evidence highlighting the substantial economic burden faced by individuals and families as a result of out-of-pocket costs for health care and their flow-on effects on healthcare access, outcomes and long-term healthcare costs. It is argued that a compulsory minimum co-payment for GP consultations will exacerbate these burdens and significantly undermine the tenets of universal access in Medicare. Alternative recommendations are provided that may help harness unsustainable health spending while promoting an equitable and fair health system.

show abstract

“…Evidence on the effect of cost-sharing for nonemergency health consequences). Evidence on the effect of cost-sharing for nonemergency outpatient utilization is more mixed (Cherkin, Grothaus, and Wagner, 1989; Remler outpatient utilization is more mixed (Cherkin, Grothaus, and Wagner, 1989;Remler and Greene, 2009). and Greene, 2009).…”

Section: Own-price Effects Own-price Effectsmentioning

confidence: 99%

Patient Cost-Sharing and Healthcare Spending Growth

Baicker¹,

Goldman

2011

Journal of Economic Perspectives

129

118

View full text Add to dashboard Cite

In this paper, we explore the role patient incentives play in slowing healthcare spending growth. Evidence suggests that while patients do indeed respond to financial incentives, cost-sharing does not uniformly improve value; rather, cost-sharing provisions must be deliberately structured and targeted to reduce care of low marginal value. Other mechanisms may be helpful in targeting particular populations or types of utilization. The spillover effects between privately insured and publicly insured populations as well as market imperfections suggest a potential role for public policy in promoting insurance design that slows spending growth while increasing the health that each dollar buys.

show abstract

Cost-Sharing: A Blunt Instrument

Cited by 62 publications

References 51 publications

Access to Care After Massachusetts’ Health Care Reform: A Safety Net Hospital Patient Survey

Access to Care After Massachusetts’ Health Care Reform: A Safety Net Hospital Patient Survey

Co-payments for health care: what is their real cost?

Patient Cost-Sharing and Healthcare Spending Growth

Contact Info

Product

Resources

About