The 2009 ACR Forum: Health Care Payment Models

Gunderman, Richard B.; Patti, John A.; Lexa, Frank J.; Weinreb, Jeffrey C.; Hillman, Bruce J.; Thrall, James H.; Neiman, Harvey L.

doi:10.1016/j.jacr.2009.09.027

Cited by 11 publications

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“…a lower concentration of poor health or low net income amongst individuals who forgo health care). In the context of bundled payments, policy makers may apply an optimally designed program to stimulate the use of in-bundle care and combine this with coinsurance fees to discourage use of out-bundle care or out-of-network providers (bundle leakage) [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

The effect of cost-sharing design characteristics on use of health care recommended by the treating physician; a discrete choice experiment

Salampessy

Alblas

Koolman

et al. 2018

BMC Health Serv Res

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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.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3598-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

The effect of cost-sharing design characteristics on use of health care recommended by the treating physician; a discrete choice experiment

Salampessy

Alblas

Koolman

et al. 2018

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…In the context of bundled payments, policy makers may apply an optimally designed program to stimulate the use of in-bundle care and combine this with coinsurance fees to discourage use of out-bundle care or out-of-network providers (bundle leakage). 113 Third, the difference in relative importance of attributes found between both groups (see Tables 3.3, 3.4 and 3.5) corresponds with the difference in demand-response to the current cost-sharing program (deductibles that are billed afterwards by the health insurer).…”

Section: Discussionmentioning

confidence: 91%

“…In the context of value-based health care and in particular bundled payments, the insights of our research may help to design costsharing programs that stimulate patients to use in-bundled care (in-network providers) by using cost-sharing payments. 113 Furthermore, findings of our subgroup analyses imply that, if carefully redesigned, cost-sharing programs may help to reduce adverse health effects of cost-sharing in certain subgroups.…”

Section: Part Ii: Price Of Care In Patient Choicementioning

confidence: 87%

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The choice of health provider from the patient perspective

Salampessij¹

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In recent years, health care consumers (patients) have increasingly been stimulated to take an active role in the decision-making process for providers (hereafter referred to as patient choice). Patient choice is assumed to increase competition between health care providers due to patients voting with their feet. In patient choice, patients are expected to make tradeoffs between the price and quality of care to selectively choose providers who best fit the patients’ preferences. Patient choice has an instrumental value as it aims at improving the efficiency of health care, at achieving better quality of care and at making health providers more responsive to the needs of patients. Patient choice has also an intrinsic value as it acknowledges the autonomy of patients. This dissertation aims to contribute to our understanding of current policies regarding patient choice by addressing research questions related to various aspects of patient choice in the context of the Dutch health care system. To answer these questions, we conducted several discrete choice experiments (DCEs) and a mixed methods study, and performed a longitudinal analysis of scores on quality indicators. The research included in this dissertation has been partitioned into the following parts: patient choice in practice (Part I), the price of care (Part II) and the quality of care (Part III). The conclusions described in this dissertation indicate that, even if patients are in fact willing to become actively involved in patient choice, patients often lack the information on price and quality of care required to make well-informed decisions and effectively exercise choice. Considering the current conditions in practice, we conclude that the underlying assumption of patient choice —i.e. patients select their providers based on information regarding the price and quality of care and in accordance with their preferences— is unlikely to hold true in practice. This overall conclusion indicates the status of “work-in-progress” for current policy regarding patient choice and underlines the need for additional efforts to achieve the goal of patient choice. This dissertation does not provide a definite answer as to whether encouraging patients to become actively involved in patient choice will be successful in achieving the goal of patient choice. Alternatively, additional efforts may be focused on facilitating referring physicians to choose providers on the patient’s behalf. This alternative approach is likely to be the most successful for several reasons. (1) Few patients actively choose their providers or are motivated to so. (2) In real-life settings, individuals are unlikely to conform with the notion of rational consumers. (3) The choice of provider strongly depends on advice of the referring physician.

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In the Blink of an Eye

Pentecost¹

2010

Journal of the American College of Radiology

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The 2009 ACR Forum: Health Care Payment Models

Cited by 11 publications

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The effect of cost-sharing design characteristics on use of health care recommended by the treating physician; a discrete choice experiment

The effect of cost-sharing design characteristics on use of health care recommended by the treating physician; a discrete choice experiment

The choice of health provider from the patient perspective

In the Blink of an Eye

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