Benefit design in health care reform: patient cost-sharing

Office of Technology Assessment
Record ID 31995000076
Authors' objectives:

The objective of this paper was to examine the health services and economics literature to learn what is known about how patient cost-sharing affects the use of health care services, expenditures, and, ultimately, health outcomes.

Authors' results and conclusions: The cost-sharing literature makes very clear a basic lesson of human nature: people will use services, even health services, less often when they have to pay for them. By keeping people out of the health care system altogether, coinsurance requirements have been found to substantially reduce health care spending. However, conventional wisdom to the contrary, there is no evidence that people make better choices and decisions about their health care when they bear some of the cost. In fact, in the HIE, coinsurance deterred individuals from seeking all types of care, even potentially effective treatment and appropriate hospitalizations. The HIE also confirmed the power of the health care provider in determining demand for medical care. HIE participants in cost-sharing plans were much less likely to seek medical attention than others, but once they did, the amount and cost of their care was largely unaffected by cost-sharing and apparently was determined principally by their physician. In addition, the HIE health-related findings are inconclusive in many respects. They do suggest, however, that some individuals, especially lower income persons in poor health, may be harmed by cost-sharing.
Authors' methods: Review
Project Status: Completed
Year Published: 1993
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: United States
MeSH Terms
  • Cost Sharing
  • Health Policy
  • Insurance, Health
  • Managed Care Programs
Organisation Name: U. S. Congress. Office of Technology Assessment
Copyright: Office of Technology Assessment
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