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

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

Costs of Breast Cancer Treatment Incurred by Women in Vietnam

“…Targeted therapy for HER2 + patients does not tend to be prescribed in Vietnam when it is known that patients cannot afford the treatment (personal communication). The effect of cost on doctor's prescribing behaviour and patient treatment decisions were documented elsewhere [28][29][30] and need further research in Vietnam. Polices involving higher HI coverage rate for targeted therapy and/or an OOP maximum (a cap on the amount of money that a patient pays for covered healthcare services plan/year) is likely to impact positively on access by patients to appropriate BC treatment.…”

Costs of breast cancer treatment incurred by women in Vietnam

“…Targeted therapy for HER2+ patients does not tend to be prescribed in Vietnam when it is known that patients cannot afford the treatment (personal communication). The effect of cost on doctor’s prescribing behaviour and patient treatment decisions were documented elsewhere [ 37 – 39 ] and need further research in Vietnam. Polices involving higher SHI reimbursement rate for targeted therapy and/or an OOP maximum (a cap on the amount of money that a patient pays for covered health services plan per year) is likely to impact positively on access by patients to appropriate BC treatment.…”

How Important Is Income in Explaining Avoidance of Care Due to Cost-Sharing Payments? Results From a Mixed Methods Sequential Explanatory Study.

“…For example, at-fee copayments paid at point of care offer individuals clear and immediate information on the required payments in advance. In a hypothetical decision context, Salampessy and colleagues have demonstrated that such payments stimulate adherence to recommended healthcare [20].…”

“…We used data collected by Salampessy and colleagues and described in detail elsewhere [20]. In short, an online questionnaire was distributed by email among panel members of the Dutch Patient Federation in March and April 2016.…”

“…Of the 7,921 respondents described by Salampessy and colleagues [20], we included 7,339 respondents (i.e., avoiders and users) in our analyses. We performed a logistic regression model in which we used deductible-related avoidance of recommended healthcare as dependent variable and included all determinants as independent variables.…”