High Cost-Sharing Policies For Physician Care May Not Benefit Chronically Ill Patients

Haichang Xin, PhD Department of Health Care Organization and policy School of Public Health University of Alabama at BirminghamMedicalResearch.com Interview with:
Haichang Xin, PhD
Department of Health Care Organization and policy
School of Public Health
University of Alabama at Birmingham

MedicalResearch: What is the background for this study?

Dr. Xin: Since high cost-sharing policies can reduce both needed care and unneeded care use, it raises the concern whether these policies are a good strategy for controlling costs among chronically ill patients, especially whether utilization and costs in emergency department (ED) service and inpatient care will increase in response. Moreover, the costs saved by reduced physician care may be offset or even exceeded by the increased ED or inpatient care expenditures, causing a total cost increase for health plans.

This study was the first to examine whether high cost-sharing policies for physician care are associated with a differential impact on total care costs between chronically ill individuals and healthy individuals. Total care includes physician care, ED service and inpatient care.

MedicalResearch: What are the main findings?

Dr. Xin:  Chronically ill individuals’ probability of reducing any overall care costs was significantly less than healthier individuals (β= 2.18, p = 0.04), while the integrated Difference-in-difference estimator from split results in the two-part model indicated that going from low cost-sharing to high cost-sharing significantly reduced costs by $12,853.23 more for sick people than for healthy people (95% CI: -$17,582.86, -$8,123.60).

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Xin:  In conclusion, compared with non-chronically ill individuals, chronically ill individuals reduced their total care costs to a greater extent in response to increased cost-sharing in physician care. Chronically ill individuals’ greater cost reductions for total care formed a sharp contrast to their higher demand for medical care compared with that of the general population. Given this, the greater cost reduction in total care among chronically ill individuals would not justify high cost-sharing policies for physician care for them, since these cost savings may have come at the expense of jeopardizing health outcomes by depriving chronically ill patients of needed care.

Findings from this study contribute to the insurance benefit design that can control care utilization and save costs of chronically ill individuals. Health plans need to be cautious of cost-sharing policies for chronically ill enrollees. A generous benefit design with low cost-sharing policies in physician care or primary care is recommended for both health plans and chronically ill individuals, to save costs and protect these enrollees’ health status.

It may be prudent to have specialized health plans for subpopulations that have chronic conditions instead of a universal plan with a one size-fits-all benefit structure. The current study contributes to the necessity and importance of designing insurance policies in terms of differentiation and specification for the target subpopulation.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Xin:  Future research may consider exploring the differential impacts on total costs over the long term, and trying to reveal a causal relationship of the research question.


How Do High Cost-Sharing Policies For Physician Care Affect Total Care Costs Among People With Chronic Disease?
Xin H

J Ambul Care Manage. 2015 Apr-Jun;38(2):100-8. doi: 10.1097/JAC.0000000000000050.

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MedicalResearch.com Interview with: Haichang Xin, PhD (2015). High Cost-Sharing Policies For Physician Care May Not Benefit Chronically Ill Patients 

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