Andrew P. Loehrer, MD, MPH Assistant Professor Department of Surgery, Division of Surgical Oncology Dartmouth-Hitchcock

Increased Cost Sharing Linked to Patients Delaying Care for Appendicitis Interview with:

Andrew P. Loehrer, MD, MPH Assistant Professor Department of Surgery, Division of Surgical Oncology Dartmouth-Hitchcock

Dr. Loehrer

Andrew P. Loehrer, MD, MPH
Assistant Professor
Department of Surgery, Division of Surgical Oncology
Dartmouth-Hitchcock What is the background for this study?

Response: Patient cost sharing represents the portion of costs covered by insurance that individuals pay out of pocket, including deductibles, co-payment, and co-insurance. Cost sharing is increasingly common and also increasingly expensive for patients with commercial health insurance across the United States.

While designed to increase patient responsibility for health care spending, prior work has shown that higher cost sharing is also associated with decreased use of health care overall, both needed and discretionary. However, little work has been done as to how high cost sharing may affect common and costly conditions like acute appendicitis and acute diverticulitis. What are the main findings? 

Response: Our study included over 150,000 patients with commercial health insurance admitted with acute appendicitis or acute diverticulitis. We found that greater cost-sharing (the more individuals were responsible for paying out of pocket) was associated with increased chance of patients presenting with more severe and complicated disease. Our findings also suggested that this delayed presentation may also influence the kind of care that patients received. What should readers take away from your report?

Response: As health insurance plans increasingly incorporate greater amount of out-of-pocket spending for patients, this may contribute to patients delays in seeking care and this in turn can lead to more complicated disease and difficulty with surgical management. What recommendations do you have for future research as a result of this work

Response: Future research should focus on how increasing cost-sharing may exacerbate existing socioeconomic and racial disparities in access to and receipt of optimal surgical care. Prospective studies or natural experiment studies could provide stronger evidence for a causal relationship between cost sharing and equity of care. This work is especially important for lower-income populations, including those with Medicaid coverage, that may be particularly vulnerable to small changes in out-of-pocket expenses. Is there anything else you would like to add?

Response: I have no conflicts to report. The work was done in collaboration between Dartmouth-Hitchcock Medical Center and the Urban Institute. This research was supported by a Health Data for Action award from the Robert Wood Johnson Foundation and AcademyHealth.


Loehrer AP, Leech MM, Weiss JE, et al. Association of Cost Sharing With Delayed and Complicated Presentation of Acute Appendicitis or Diverticulitis. JAMA Health Forum. 2021;2(9):e212324. doi:10.1001/jamahealthforum.2021.2324


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Sep 7, 2021 @ 11:35 pm

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