Value-based Insurance Results

The purpose of value-based insurance is to design copays, coinsurance, deductibles and other benefit features that will encourage people to use services that have been demonstrated to be cost-effective, while discouraging use of services for which there is less certain evidence of beneficial effects.  These designs have been around long enough now that researchers have examined their effects on both quality and costs.  An article in Health Affairs reviews the results of these early studies.  (Health Affairs Article)   All of the studies focused on prescription drugs, which typically have elaborate copay designs.   Thirteen studies were selected, all of which involved copayment reductions on drugs that treated chronic diseases.  The studies were all considered to have good to excellent methodological quality.   All of the studies showed an improvement in medication adherence after one year, by an average of 3%.  Some showed continuing adherence gains beyond one year.  The adherence response varied across drug types.  Several of the studies examined a potential effect of copay reductions on medical and drug spending.  As might be expected, drug spending rose.  The effect on overall health spending was less clear, but appeared to be an insignificant change, up or down although some individual studies showed an increase and some a decrease.  Two studies looked at utilization and found decreases in ER use, physician visits and hospitalizations.   An important future goal of research should be to track overall spending and utilization changes in the long run.