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

• Author: Jeffrey S. Harman,Haichang Xin
• DOI: http://doi.org/10.1002/wmh3.136
• Published date: 01 June 2015
• Date: 01 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

137

1948-4682 #2015 Policy Studies Organization

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