Trends in Patient Cost Sharing for Clinical Services Used as Quality Indicators

Chernew, Michael E.; Gibson, Teresa B.; Fendrick, A. Mark

doi:10.1007/s11606-009-1219-y

Cited by 8 publications

(7 citation statements)

References 6 publications

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“…Precision benefit designs that alter cost-sharing based on a specific individual's clinical course could serve to reward patients who follow recommended treatment paths. [25][26][27][28] Until recently, plan sponsors offering health savings account-qualified HDHPs were constrained in their ability to pursue this strategy. In July 2019, the US Department of the Treasury released A, Difference in all medications from 2013 to 2014 was −3.3% for the non-highdeductible health plan (HDHP) cohort (orange line); −1.8% for the HDHP cohort (blue line); and 1.5% for the difference-in-differences estimated comparison.…”

Section: Discussionmentioning

confidence: 99%

Association Between Switching to a High-Deductible Health Plan and Discontinuation of Type 2 Diabetes Treatment

et al. 2019

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IMPORTANCE High-deductible health plans (HDHPs) are a common cost-savings option for employers but may lead to underuse of necessary treatments because beneficiaries bear the full cost of health care, including medications, until a deductible is met. OBJECTIVES To evaluate the association between switching from a non-HDHP to an HDHP and discontinuation of antihyperglycemic medication and to assess whether the association differs in patients using branded vs generic antihyperglycemic medications. DESIGN, SETTING, AND PARTICIPANTS This retrospective matched cohort study used administrative claims from MarketScan databases to identify commercially insured adult patients with type 2 diabetes who used at least 1 antihyperglycemic medication in 2013. Patients in the HDHP cohort (n = 1490) were matched by propensity scores to a non-HDPH control cohort (n = 1490).

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Section: Discussionmentioning

confidence: 99%

Association Between Switching to a High-Deductible Health Plan and Discontinuation of Type 2 Diabetes Treatment

et al. 2019

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“…Currently, for physician-administered drugs and their companion diagnostics, Medicare Part B's fixed co-insurance rate of 20% bears no relationship to the clinical-and cost-effectiveness of a drug [32]. Furthermore, for self-administered drugs (covered under Medicare's Part D program) and their companion diagnostics, there does not appear to be anything other than acquisition cost that determines cost-sharing [33]. Will Medicare's payment policies for physician-and self-administered drugs change?…”

Section: Conclusion Policy Implicationsmentioning

confidence: 99%

Overcoming regulatory and economic challenges facing pharmacogenomics

Cohen¹

2012

New Biotechnology

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“…6 Eliminating cost sharing has been associated with increased screening use, [16][17][18] or slower declines in use. 19 From 2001 to 2006, copayments for cancer screening and other services within commercial insurance plans increased 20 and cost sharing became more frequent in some plans. 6 The Affordable Care Act (ACA) of 2010 eliminated costsharing barriers for certain recommended preventive services obtained in-network in many insurance plans.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Out-Of-Pocket Payments for Mammography Screening Among Recently Screened Women

Sabatino

Thompson

Miller

et al. 2019

Journal of Women's Health

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Background: Because cost may be a barrier to receiving mammography screening, cost sharing for ''innetwork'' screening mammograms was eliminated in many insurance plans with implementation of the Affordable Care Act. We examined prevalence of out-of-pocket payments for screening mammography after elimination in many plans. Materials and Methods: Using 2015 National Health Interview Survey data, we examined whether women aged 50-74 years who had screening mammography within the previous year (n = 3,278) reported paying any cost for mammograms. Logistic regression models stratified by age (50-64 and 65-74 years) examined out-ofpocket payment by demographics and insurance (ages 50-64 years: private, Medicaid, other, and uninsured; ages 65-74 years: private-Medicare, Medicare+Medicaid, Medicare Advantage, Medicare only, and other). Results: Of women aged 50-64 years, 23.5% reported payment, including 39.1% of uninsured women. Compared with that of privately insured women, payment was less likely for women with Medicaid (adjusted OR 0.17 [95% CI 0.07-0.41]) or other insurance (0.49 [0.25-0.96]) and more likely for uninsured women (1.99 [0.99-4.02]) (p < 0.001 across groups). For women aged 65-74 years, 11.9% reported payment, including 22.5% of Medicare-only beneficiaries. Compared with private-Medicare beneficiaries, payment was less likely for Medicare+Medicaid beneficiaries (adjusted OR 0.21 [95% CI 0.06-0.73]) and more likely for Medicareonly beneficiaries (1.83 [1.01-3.32]) (p = 0.005 across groups). Conclusions: Although most women reported no payment for their most recent screening mammogram in 2015, some payment was reported by >20% of women aged 50-64 years or aged 65-74 years with Medicare only, and by almost 40% of uninsured women aged 50-64 years. Efforts are needed to understand why many women in some groups report paying out of pocket for mammograms and whether this impacts screening use.

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Trends in Patient Cost Sharing for Clinical Services Used as Quality Indicators

Cited by 8 publications

References 6 publications

Association Between Switching to a High-Deductible Health Plan and Discontinuation of Type 2 Diabetes Treatment

Association Between Switching to a High-Deductible Health Plan and Discontinuation of Type 2 Diabetes Treatment

Overcoming regulatory and economic challenges facing pharmacogenomics

Prevalence of Out-Of-Pocket Payments for Mammography Screening Among Recently Screened Women

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