Some interim results from a controlled trial of cost sharing in health insurance

The reports of Valdez et al1 and Leibowitz et al2 mark the culmination of a landmark effort. Initiated over a decade ago, the Rand Health Insurance Experiment—the most ambitious and expensive randomized controlled trial ever conducted in health services research—was designed to produce estimates of the costs of various forms of national health insurance. Projected estimates of the costs of Medicaid and Medicare had been far too low and health policy experts hoped to obtain information that would prove closer to the mark in the (then) seemingly likely passage of some form of national health insurance. Although national health insurance has not materialized, the impact of medical care costs on utilization of services and health status is still of great interest. The amount of "cost-sharing" (medical costs paid by patients) has increased dramatically in public insurance programs, and many health policymakers favor increases in private insurance programs. The central question now, however, is how much of the cost burden can be borne by patients without inducing reductions in utilization that are harmful to health. The two papers1,2 in the May issue of Pediatrics reported on the impact of cost-sharing on children's utilization and health. The basic findings were similar to those for adults. In general, the higher the costs paid by families, the fewer the children receiving medical care and the fewer the services per user. The only exception was hospitalization of children aged 5 to 13, which was largely unaffected by cost-sharing; higher costs did appear to reduce hospitalization of younger children, as well as ambulatory care for children of all ages.

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Some interim results from a controlled trial of cost sharing in health insurance

Studying the Organisation and Delivery of Health Services ◽

10.4324/9780203337394-47 ◽

2004 ◽

pp. 265-272

Keyword(s):

Health Insurance ◽

Cost Sharing ◽

Controlled Trial

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Understanding the distributional impacts of health insurance reform: Evidence from a consumer cost‐sharing program

Health Economics ◽

10.1002/hec.4410 ◽

2021 ◽

Author(s):

Marion Aouad ◽

Timothy T. Brown ◽

Christopher M. Whaley

Keyword(s):

Health Insurance ◽

Cost Sharing ◽

Insurance Reform ◽

Health Insurance Reform ◽

Distributional Impacts

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Renewed Emphasis On Consumer Cost Sharing In Health Insurance Benefit Design

Health Affairs ◽

10.1377/hlthaff.w2.139 ◽

2002 ◽

Vol 21 (Suppl1) ◽

pp. W139-W154 ◽

Cited By ~ 17

Author(s):

James C. Robinson

Keyword(s):

Health Insurance ◽

Cost Sharing ◽

Benefit Design ◽

Insurance Benefit

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Patient out-of-pocket spending in cranial neurosurgery: single-institution analysis of 6569 consecutive cases and literature review

Neurosurgical FOCUS ◽

10.3171/2018.1.focus17782 ◽

2018 ◽

Vol 44 (5) ◽

pp. E6 ◽

Cited By ~ 6

Author(s):

Seungwon Yoon ◽

Michael A. Mooney ◽

Michael A. Bohl ◽

John P. Sheehy ◽

Peter Nakaji ◽

...

Keyword(s):

Health Insurance ◽

Cost Sharing ◽

Financial Burden ◽

Vascular Lesions ◽

Annual Growth Rate ◽

Model Case ◽

Patient Cost ◽

Neurosurgical Patients ◽

The Mean ◽

Insured Patients

OBJECTIVEWith drastic changes to the health insurance market, patient cost sharing has significantly increased in recent years. However, the patient financial burden, or out-of-pocket (OOP) costs, for surgical procedures is poorly understood. The goal of this study was to analyze patient OOP spending in cranial neurosurgery and identify drivers of OOP spending growth.METHODSFor 6569 consecutive patients who underwent cranial neurosurgery from 2013 to 2016 at the authors’ institution, the authors created univariate and multivariate mixed-effects models to investigate the effect of patient demographic and clinical factors on patient OOP spending. The authors examined OOP payments stratified into 10 subsets of case categories and created a generalized linear model to study the growth of OOP spending over time.RESULTSIn the multivariate model, case categories (craniotomy for pain, tumor, and vascular lesions), commercial insurance, and out-of-network plans were significant predictors of higher OOP payments for patients (all p < 0.05). Patient spending varied substantially across procedure types, with patients undergoing craniotomy for pain ($1151 ± $209) having the highest mean OOP payments. On average, commercially insured patients spent nearly twice as much in OOP payments as the overall population. From 2013 to 2016, the mean patient OOP spending increased 17%, from $598 to $698 per patient encounter. Commercially insured patients experienced more significant growth in OOP spending, with a cumulative rate of growth of 42% ($991 in 2013 to $1403 in 2016).CONCLUSIONSEven after controlling for inflation, case-mix differences, and partial fiscal periods, OOP spending for cranial neurosurgery patients significantly increased from 2013 to 2016. The mean OOP spending for commercially insured neurosurgical patients exceeded $1400 in 2016, with an average annual growth rate of 13%. As patient cost sharing in health insurance plans becomes more prevalent, patients and providers must consider the potential financial burden for patients receiving specialized neurosurgical care.

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