Are High Cost‐Sharing Policies for Physician Care Associated With Reduced Care Utilization and Costs Differently by Health Status?

AuthorJeffrey S. Harman,Haichang Xin
Published date01 June 2015
Date01 June 2015
Are High Cost-Sharing Policies for Physician Care
Associated With Reduced Care Utilization and Costs
Differently by Health Status?
Haichang Xin and Jeffrey S. Harman
The study examined whether high cost-sharing policies for physician care are associated with
reduced care utilization and costs differently between individuals with and without chronic
conditions. Findings from this study contribute to the benef‌it structure design of health plans that
may improve care delivery eff‌iciencies and maintain health outcomes among chronically ill
individuals. The study used the 2010–2011 Medical Expenditure Panel Survey data with a
retrospective cohort study design. Difference in difference, negative binomial regression, and
generalized linear models were employed to analyze the utilization and cost data. In order to
account for national survey sampling design, weight and variance were adjusted. The study sample
consisted of 4,368 individuals. Multivariate analysis and sensitivity analysis found consistent
patterns between utilization and cost models. High cost-sharing policies for physician care were not
associated with different levels of reductions in care utilization and costs between chronically ill
people and healthy people (all at p >0.05). However, the stratif‌ication analysis indicated that
chronically ill people reduced physician care use and costs to the similarly signif‌icant extent as
healthy people in response to high cost-sharing policies. Relative to non-chronically ill individuals,
chronically ill individuals may decrease their care utilization and expenditures to a similarly
signif‌icant extent in response to increased physician care cost sharing. This may be due to patients’
inability to discern care cost-effectiveness, a short observation window, and chronic condition
characteristics. It is possible that, in the long run, these sick people would demonstrate substantial
demands for downstream medical care, such as inpatient care, and there could ultimately be a total
cost increase for them and their families at the micro level. Health plans need to be cautious of
policies for chronically ill private enrollees, such as considering a low cost-sharing policy for
physician care or primary care. Individuals with chronic conditions may consider insurance plans
with low levels of cost sharing in physician care, especially when more public information about
health plan features and designs is available to facilitate their decision-making process. Future
studies should examine this research question with a longer observation period and with more
measures, such as physician behaviors.
KEY WORDS: high cost-sharing policies, physician care, utilization and costs, chronic disease
World Medical & Health Policy, Vol. 7, No. 2, 2015
1948-4682 #2015 Policy Studies Organization
Published by Wiley Periodicals, Inc., 350 Main Street, Malden, MA 02148, USA, and 9600 Garsington Road, Oxford, OX4 2DQ.

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