Cost-Sharing and Outcomes

The continuing adoption of more consumer cost-sharing for health care expenses has sparked research and debate over its effect on health outcomes.  The Robert Wood Johnson foundation released a summary and perspective on the topic.   (RWJ Report) The report acknowledges that lack of cost-sharing encourages use of unnecessary or inappropriate services, but notes that most research has shown that consumers with higher cost sharing tend to eliminate necessary as well as unnecessary care, potentially leading to higher costs in the long run.

The report expresses concern that patients with high cost-sharing may not be able to make informed, rational choices about their health care, and that this tendency is more pronounced among low-income citizens and other vulnerable populations, such as the elderly.   In particular, while research suggests that the average person does not have worse health outcomes because of cost-sharing, even when they eliminate what is deemed necessary care, for low-income and other vulnerable populations, cost-sharing does appear to lead to worse outcomes.

This report has a clear bias, reflected in the way it discusses things like changes in health care services, insurance design and income inequality.  Numbers tend to be used in ways that favor the authors’ bias.  The authors also totally ignore the fiscal crisis faced by this country, a crisis which one way or another is going to mean there is less money available for health care in public programs, which tend to pay for most care for “vulnerable” populations.  Most of the people in these populations have made and continue to make a series of bad life choices that lead to their health care needs.  Without consequences they have no incentive to stop that behavior and how fair is it for other people who do act responsibly to have to pay for irresponsible ones.  Nonetheless, the impact of increased cost borne by consumers is a very serious one.   The notion of value-based insurance design has the potential to blunt any negative impacts and should be adopted by plans.  Continued research is also important to focus on maximizing consumer understanding of their coverage and how to use it sensibly.