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1.
Front Public Health ; 10: 924992, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36117604

RESUMO

Introduction: Patient and/or physician responses are a pivotal issue in designing rational cost-sharing programs under health insurance systems. Objectives: This study aims to understand patient and/or physician responses to cost-sharing programs designed for prescription drugs in South Korea. Methods: As a framework, we took advantage of a tiered cost-sharing program, including from copayment to coinsurance (threshold 1) and reduced coinsurance (threshold 2). Given the hierarchical structure of prescriptions nested within patients, we utilized a multilevel analysis to assess effects of various cost-sharing programs on patient and/or physician responses using National Health Insurance claims data from 2018. Results: We found that a tiered cost-sharing program was effective in changing the behaviors of patients and/or physicians. Threshold 1 was found to be more effective than threshold 2 in changing their behaviors. At the prescription level, sensitivity to cost-sharing programs was associated with prescribed days of treatment and locations of prescription. In a similar vein, sensitivity to cost-sharing programs was associated with gender and age group of patients. Conclusion: A simplified cost-sharing program with extended intervals should be considered to rationalize cost-sharing programs. Specifically, a cost-sharing program designed for long-term prescriptions for chronic diseases together with an emphasis on cost transparency is required to better guide price-conscious decisions by patients and/or physicians.


Assuntos
Médicos , Medicamentos sob Prescrição , Custo Compartilhado de Seguro , Humanos , Análise Multinível , República da Coreia
3.
J Health Econ ; 85: 102663, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35944308

RESUMO

In this paper, I study tiered cost sharing, an innovative incentive structure designed to steer patients toward low-cost providers using large out-of-pocket price differentials. Using administrative data from New Hampshire, where two large insurers utilize tiered pricing programs, I estimate the effects of tiering on choices and spending for common gastrointestinal endoscopic procedures. I first conduct a difference-in-differences analysis using the rollout of one insurer's tiered option. I then develop and estimate a demand model to explicitly compare the tiered design with other common plans. Both the reduced form and structural models imply that the tiered plans are associated with 4.5%-6.3% less in mean per-episode spending than high-deductible and coinsurance-based plans, and do not affect the likelihood of seeking care. I find evidence that the savings is in part due to a salience or "simple pricing" effect whereby patients respond to tiered out-of-pocket prices but not to traditional deductibles or coinsurance rates.


Assuntos
Custo Compartilhado de Seguro , Dedutíveis e Cosseguros , Atenção à Saúde , Gastos em Saúde , Humanos , Seguradoras , Estados Unidos
5.
Med Care ; 60(9): 718-725, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35866553

RESUMO

BACKGROUND: Lack of affordable health care affects the uninsured, commercially insured, and Medicare beneficiaries. Yet, the wide variation in providers' prices and practice styles suggests that more affordable care already may be available and data on low value and wasteful care suggest that lower cost care need not come at the expense of better quality. Although price variation has received the most attention in the literature and legislation, total cost of care is a function of both unit prices (fees) and the quantity of services. OBJECTIVE: To partition provider-specific variation in total annual risk-adjusted per capita expenditures on health care services into variation in unit prices (fees) versus quantities of services, and to explore the relationship between low value, avoidable, discretionary, and recommended care to total health expenditures. The analysis is important because both prices and quantities of services can affect affordability and reductions in prices versus quantities have very different effects on providers' profits. SETTING: 2018 data from the Minnesota State Employees Group Insurance Program (SEGIP) that offers a tiered cost-sharing health insurance benefit design to 130,000 State employees and their dependents (SEGIP "members"). EXPOSURE: Each year during open enrollment, SEGIP members choose a primary care clinic (PCC). The PCC can make decisions regarding both unit prices and prescribed services. PCCs are placed in one of four cost-sharing tiers based on the total annual risk-adjusted per capita health expenditures for the SEGIP members who choose their clinic. Members choosing higher cost PCCs face higher deductibles, copayments, and maximum out-of-pocket spending limits. MEASURES: Overall prices and use of inpatient, outpatient hospital, professional, and pharmaceutical services, total and avoidable use of emergency department visits and inpatient admissions, low value care, testing for patients with pneumonia, and recommended preventive care. RESULTS: Differences in total risk-adjusted annual per capita health expenditures across the care systems were substantial. Higher cost providers had both higher unit prices and higher use of services. Variation in the quantity of health care services explained more of the variance in total spending than variation in prices. Prices for professional services and use of inpatient, outpatient hospital, and pharmaceutical services, and ambulatory care sensitive admissions, contributed significantly to high total expenditures. Lower cost PCCs in the lowest cost-sharing tier had higher rates of low value care and lower emergency department visits per capita. Neither the number of investigations for patients with pneumonia nor the receipt of recommended mammography screening varied systematically by tier. CONCLUSIONS: Efforts to identify and expand sources of affordable care, including improved information and incentives for consumers, need to account for variation in both prices and quantities of services. Efforts to encourage more efficient use of health care services by providers need to consider the effect of those efforts on the provider's internal costs and thus their profits.


Assuntos
Custo Compartilhado de Seguro , Medicare , Idoso , Assistência Ambulatorial , Atenção à Saúde , Gastos em Saúde , Humanos , Estados Unidos
8.
Value Health ; 25(5): 803-809, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35500950

RESUMO

OBJECTIVES: Publications assessing health and economic outcomes of risk-sharing arrangements (RSAs) are limited. Better knowledge of these outcomes would shed light on the pertinence of such arrangements, informing design improvements for the future. The aim of the study is to describe the different types of RSAs implemented in Catalonia and their health and economic outcomes. METHODS: Retrospective descriptive analysis of RSAs implemented from January 2016 to December 2019 in the Catalan Health Service, CatSalut. Individual RSAs were reviewed and categorized according to standard RSA guidelines. Relevant health and economic outcomes pertaining to the RSAs were analyzed using aggregate data recorded in Catalan central registries. RESULTS: A total of 15 RSAs were implemented over the study period (10 of which are still ongoing). A total of 8 consisted of performance-linked reimbursements (PLRs) and 7 of cost-sharing arrangements (CSAs). The arrangements were implemented in the oncohematology (n = 11), rare disease (n = 3), and neurology (n = 1) areas. A total of 951 patients were included in PLR and 73% achieved the target health outcomes. Total medication costs were €9 295 755 of which 11% were refunded to CatSalut. CSAs involved 2066 patients and resulted in overall refunds of €1 349 564 (2.61%) for CatSalut. CONCLUSIONS: Both PLRs and CSAs were used to manage the different uncertainties related to accessing innovative medicines in Catalonia. The data generated provide relevant information to inform decision-making, allowing an adaptation of the initial recommendation for use and access. Additional efforts are required to increase the RSA assessments and their publication.


Assuntos
Custo Compartilhado de Seguro , Custos de Medicamentos , Humanos , Estudos Retrospectivos , Espanha
10.
J Manag Care Spec Pharm ; 28(5): 584, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35471067

RESUMO

Disclosures: S. Rotolo has no conflicts of interest to disclose. No funding was received for any portion of this work.


Assuntos
Conflito de Interesses , Revelação , Custo Compartilhado de Seguro , Humanos
11.
Am J Health Promot ; 36(4): 740-745, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35420449

RESUMO

In 2015, the Centers for Medicare and Medicaid Services announced the Medicare Advantage (MA) Value-Based Insurance Design (VBID) model test, which allows MA insurers to use flexible benefit design strategies, such as reduced cost-sharing, to encourage beneficiaries with chronic disease to use high-value care. During the first year of implementation (2017), nine MA insurers offered VBID in 45 health plans to a total of 96 053 eligible beneficiaries. We used MA encounter data to estimate the impact of VBID on health services utilization in 2017 using a difference-in-differences research design. We found that VBID increased use of 10 out of 18 targeted services, and led to general increases in primary care visits, specialty care visits, and drug fills across eligible beneficiaries. The model was also associated with increases in ambulatory care sensitive inpatient and emergency department visits, an unanticipated effect that may be temporary. Overall, our findings suggest that VBID successfully increased the use of high-value services among eligible MA beneficiaries, an important first step along the pathway to better chronic disease management, lower spending, and improved beneficiary health.


Assuntos
Medicare Part C , Seguro de Saúde Baseado em Valor , Idoso , Custo Compartilhado de Seguro , Humanos , Seguradoras , Aceitação pelo Paciente de Cuidados de Saúde , Estados Unidos
12.
Health Econ ; 31(6): 1202-1227, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35373436

RESUMO

The assumption of patient-regarding physicians has been widely adopted in the health economics literature. Physicians' patient-regarding preferences are often described as the concern for the health benefits of medical treatments, and thus closely related to the norms and ethics of the medical profession. In this paper, we ask whether physicians' patient-regarding preferences include a concern for their patient's consumption opportunities alongside patient's health benefits. To identify and quantify physicians' preferences, we design and conduct an incentivized laboratory experiment where choices determine separately the health benefits and the consumption opportunities of a real patient admitted to the nearest hospital. We find strong evidence that future physicians care about their patients' consumption opportunities.


Assuntos
Médicos , Custo Compartilhado de Seguro , Humanos , Preferência do Paciente , Relações Médico-Paciente
13.
J Occup Environ Med ; 64(3): 218-225, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-35244086

RESUMO

OBJECTIVE: To systematically review studies that evaluated the impact of employer-led efforts in the United States to improve the value of health spending, where employers have implemented changes to their health benefits to reduce costs while improving or maintaining quality. METHODS: We included all studies of employer-led health benefit strategies that reported outcomes for both employer health spending and employee health outcomes. RESULTS: Our search returned 44 studies of employer health benefit changes that included measures of both health spending and quality. The most promising efforts were those that lowered or eliminated cost sharing for primary care or medications for chronic illnesses. High deductible health plans with a savings option appeared less promising. CONCLUSIONS: More research is needed on the characteristics and contexts in which these benefit changes were implemented, and on actions that address employers' current concerns.


Assuntos
Planos de Assistência de Saúde para Empregados , Custo Compartilhado de Seguro , Humanos , Benefícios do Seguro , Estados Unidos
14.
BMC Health Serv Res ; 22(1): 297, 2022 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-35241088

RESUMO

BACKGROUND: Increasing spending and use of prescription drugs pose an important challenge to governments that seek to expand health insurance coverage to improve population health while controlling public expenditures. Patient cost-sharing such as deductibles and coinsurance is widely used with aim to control healthcare expenditures without adversely affecting health. METHODS: We conducted a systematic umbrella review with a quality assessment of included studies to examine the association of prescription drug insurance and cost-sharing with drug use, health services use, and health. We searched five electronic bibliographic databases, hand-searched eight specialty journals and two working paper repositories, and examined references of relevant reviews. At least two reviewers independently screened the articles, extracted the characteristics, methods, and main results, and assessed the quality of each included study. RESULTS: We identified 38 reviews. We found consistent evidence that having drug insurance and lower cost-sharing among the insured were associated with increased drug use while the lack or loss of drug insurance and higher drug cost-sharing were associated with decreased drug use. We also found consistent evidence that the poor, the chronically ill, seniors and children were similarly responsive to changes in insurance and cost-sharing. We found that drug insurance and lower drug cost-sharing were associated with lower healthcare services utilization including emergency room visits, hospitalizations, and outpatient visits. We did not find consistent evidence of an association between drug insurance or cost-sharing and health. Lastly, we did not find any evidence that the association between drug insurance or cost-sharing and drug use, health services use or health differed by socioeconomic status, health status, age or sex. CONCLUSIONS: Given that the poor or near-poor often report substantially lower drug insurance coverage, universal pharmacare would likely increase drug use among lower-income populations relative to higher-income populations. On net, it is probable that health services use could decrease with universal pharmacare among those who gain drug insurance. Such cross-price effects of extending drug coverage should be included in costing simulations.


Assuntos
Medicamentos sob Prescrição , Criança , Custo Compartilhado de Seguro , Dedutíveis e Cosseguros , Serviços de Saúde , Humanos , Seguro Saúde , Seguro de Serviços Farmacêuticos , Medicamentos sob Prescrição/uso terapêutico
15.
Med Care ; 60(5): 375-380, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35250021

RESUMO

BACKGROUND: Commercial health plans establish networks and require much higher cost sharing for out-of-network (OON) care. Yet, the adequacy of health plan networks for access to pediatric specialists, especially for children with medical complexity, is largely unknown. OBJECTIVE: To examine differences in OON care and associated cost-sharing payments for commercially insured children with different levels of medical complexity. DESIGN: Cross-sectional study using a nationwide commercial claims database. SUBJECTS: Enrollees 0-18 years old in employer-sponsored insurance plans. The Pediatric Medical Complexity Algorithm was used to classify individuals into 3 levels of medical complexity: children with no chronic disease, children with non-complex chronic diseases, and children with complex chronic diseases. MAIN OUTCOMES: OON care rates, cost-sharing payments for OON care and in-network care, OON cost sharing as a proportion of total health care spending, and OON cost sharing as a proportion of total cost sharing. RESULTS: The study sample included 6,399,006 individuals with no chronic disease, 1,674,450 with noncomplex chronic diseases, and 603,237 with complex chronic diseases. Children with noncomplex chronic diseases were more likely to encounter OON care by 6.77 percentage points with higher cost-sharing by $288 for OON care, relative to those with no chronic disease. For those with complex chronic diseases, these differences rose to 16.08 percentage points and $599, respectively. Among children who saw behavioral health providers, rates of OON care were especially high. CONCLUSIONS: Commercially insured children with medical complexity experience higher rates of OON care with higher OON cost-sharing payments compared with those with no chronic disease.


Assuntos
Custo Compartilhado de Seguro , Seguro Saúde , Adolescente , Criança , Pré-Escolar , Doença Crônica , Estudos Transversais , Bases de Dados Factuais , Humanos , Lactente , Recém-Nascido , Estados Unidos
17.
Value Health ; 25(3): 427-434, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35227455

RESUMO

OBJECTIVES: Most spending for prescription drugs is on branded drugs that do not have direct generic equivalents but many of these drugs do have therapeutic alternatives within class. We estimate the potential savings from providing patients a financial incentive to switch from a higher cost drug to a lower cost, therapeutic alternative drug. METHODS: We used individual state-transition microsimulations to model medication use and spending with and without financial incentives over a 12-month time horizon with a healthcare sector perspective. Costs and utilization inputs were from individuals on branded insulins or multiple sclerosis drugs enrolled in a regional mixed-model health maintenance organization. Base-case model used a one-time financial incentive of $83 and $250 offered to patients on higher cost insulin and multiple sclerosis treatments, respectively, to switch to lower cost drugs within class. RESULTS: Savings per individual offered an incentive in the insulin and multiple sclerosis classes were, respectively, $84 (95% CI $46-$122) and $2,127 (95% CI $267-$3,987). Varying the incentive size and switch probability resulted in maximum savings of $712 at elasticity of 0.2 and incentive size $250 for the insulin drug class. For the multiple sclerosis drug class, maximum savings of $5945 was at elasticity of 0.2 and incentive size of $1000. Short time horizon makes our savings estimates conservative. CONCLUSIONS: If programs such as financial incentives could encourage even a small proportion of patients to switch among drugs within therapeutic class, then substantial savings could be generated.


Assuntos
Honorários Farmacêuticos/estatística & dados numéricos , Motivação , Medicamentos sob Prescrição/economia , Adolescente , Adulto , Simulação por Computador , Custo Compartilhado de Seguro , Tomada de Decisões , Feminino , Humanos , Insulina/economia , Revisão da Utilização de Seguros , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Modelos Econômicos , Esclerose Múltipla/tratamento farmacológico , Participação do Paciente/métodos , Estados Unidos , Adulto Jovem
18.
Artigo em Inglês | MEDLINE | ID: mdl-35270792

RESUMO

The environmental awareness of consumers and enterprises has gradually increased, and green production and green consumption have become the main theme of social economy. On the other hand, the complementary product market has become an important source of competitive advantage for enterprises. Considering a complementary product supply chain, and taking account of the consumers' environmental awareness and the green subsidies provided by the government, this paper examines members' decisions in relation to four contract models based on game theory. By solving the model, it is shown that the government's green subsidy plan improves the green degree of subsidized products and complementary products. Furthermore, compared to wholesale price contracts, revenue-sharing and cost-sharing contracts motivate manufacturers to improve the greenness of subsidized products, and they achieve a Pareto improvement for the whole supply chain and its members, when the contract parameters are appropriate. Numerical experiments also reveal that both the greenness of the complementary products and the profit for members increase with the green innovation spillover effect as a result of the complementary products and the scale of green consumers with environmental awareness in the market. This study provides good guidance for decision-making concerning the complementary product supply chain, and further contributes to environmental protection.


Assuntos
Comércio , Comportamento do Consumidor , Contratos , Custo Compartilhado de Seguro , Governo
19.
Health Serv Res ; 57(5): 1112-1120, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35297507

RESUMO

OBJECTIVE: To evaluate the effects of preferred pharmacy networks-a tool that Medicare Part D plans have recently adopted to steer patients to lower cost pharmacies-on the use of preferred pharmacies and factors underlying beneficiaries' decisions on whether to switch to preferred pharmacies. DATA SOURCES: Medicare claims data were collected for a nationally representative 20% sample of beneficiaries during 2010-2016 and merged with annual Part D pharmacy network files. STUDY DESIGN: We examined preferred networks' impact on pharmacy choice by estimating a difference-in-differences model comparing preferred pharmacies' claim share before and after implementation among unsubsidized and subsidized beneficiaries. Additionally, we evaluated the factors affecting whether a beneficiary switched from mainly using nonpreferred to preferred pharmacies. DATA COLLECTION/EXTRACTION METHODS: We examined stand-alone drug plans that adopted a preferred network during 2011-2016. Our main sample included beneficiaries 65 years and older who stayed in their plan in both the first year of implementation and the year before and whose cost-sharing subsidy status and ZIP code remained unchanged during the 2-year period. PRINCIPAL FINDINGS: Unsubsidized Part D beneficiaries faced an average difference of $129 per year in out-of-pocket spending between using nonpreferred and preferred pharmacies, while subsidized beneficiaries were insulated from these cost differences. The implementation of preferred networks resulted in a 3.7-percentage point (95% CI: 3.3, 4.2) increase in preferred pharmacies' claim share in the first year among the unsubsidized. Existing relationships with preferred pharmacies, the size of financial incentives, proximity to preferred pharmacies, and urban residence were positively associated with beneficiaries' decisions to switch to these pharmacies. CONCLUSIONS: Preferred pharmacy networks caused a moderate shift on average towards preferred pharmacies among unsubsidized beneficiaries, although stronger financial incentives correlated with more switching. Researchers and policymakers should better understand plans' cost-sharing strategies and assess whether communities have equitable access to preferred pharmacies.


Assuntos
Medicare Part D , Assistência Farmacêutica , Farmácias , Farmácia , Idoso , Custo Compartilhado de Seguro , Humanos , Estados Unidos
20.
Artigo em Inglês | MEDLINE | ID: mdl-35270349

RESUMO

To mitigate climate change, the governments of various countries have formulated and implemented corresponding low-carbon emission reduction policies. Meanwhile, consumers' awareness of the necessity of environmental protection is gradually improving, and more consumers pay attention to the environmental attributes of products, which all encourages enterprises to have great power to implement low carbon technology. As rational decision makers, members tend to show the characteristics of risk aversion. How to meet the needs of consumers and reduce their own risks has become a key point of low-carbon supply chain management. Considering carbon quota policy, in this paper, the optimal pricing decision-making process of a supply chain system is discussed under risk-neutral and risk-avoidance decision-making scenarios by game theory, and a cost-sharing contract is used to coordinate the decision-making process of a supply chain system. By analyzing the influence of the risk aversion coefficient on the optimal strategies of participants, we find that when the manufacturer has the risk aversion characteristic, the risk aversion coefficient will further reduce the carbon emission rate, the wholesale price of the product and the manufacturer's profit but increase the product order quantity and the retailer's profit. In addition, if consumers have a high preference for low-carbon products, the manufacturer's risk-aversion coefficient will lead to a lower selling price than in the centralized decision-making situation, and the profit of the supply chain system will also be further reduced. When the cost-sharing contract is adopted for coordination, the Pareto improvement of supply chain members' profits can be achieved when the parameters of the cost-sharing contract are appropriate, regardless of the manufacturer's risk-neutral decision or risk-aversion decision.


Assuntos
Comércio , Comportamento do Consumidor , Carbono , Custo Compartilhado de Seguro , Humanos , Políticas
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