Estudiante

 RESEARCH 

Effects of Cost Sharing on Care Seeking and Health Status: Results From the Medical Outcomes Study
| Mitchell D. Wong, MD, PhD, Ronald Andersen, PhD, Cathy D. Sherbourne, PhD, Ron D. Hays, PhD, and Martin F. Shapiro, MD, PhD
Requiring patients to pay a portion of their medical bill out of pocket, also known as cost sharing, sharply reduces their use of health care resources.1–9Use of this strategy by health insurance plans to lower expenditures is controversial: proponents argue that health care consumers will appropriately ration their use of medical services; critics fear that this financial disincentive will lead patients to use less care that may be necessary and will result in worse health outcomes. The RAND Health Insurance Experiment, which randomized subjects tohealth plans with varying coinsurance levels, did not provide a definitive judgment in regard to these issues. Relative to free care, coinsurance reduced use of both unnecessary and necessary care1,4 but had only a small adverse effect on health outcomes.1,10,11 Because the study excluded disabled and elderly individuals, subjects may have been too healthy for a greater negative health effect tobe observed. Thus, we analyzed data from the Medical Outcomes Study, which prospectively followed chronically ill adults, to determine whether cost sharing deters use of care and leads to subsequent worse health outcomes among a population whose health may be more vulnerable to use disincentives.

Objectives. This study sought to determine the effect of cost sharing on medical care use for acutesymptoms and on health status among chronically ill adults. Methods. Data from the Medical Outcomes Study were used to compare (1) rates of physician care use for minor and serious symptoms and (2) 6- and 12-month follow-up physical and mental health status among individuals at different levels of cost sharing. Results. In comparison with a no-copay group, the low- and high-copay groups were lesslikely to have sought care for minor symptoms, but only the high-copay group had a lower rate of seeking care for serious symptoms. Follow-up physical and mental health status scores were similar among the 3 copay groups. Conclusions. In a chronically ill population, cost sharing reduced the use of care for both minor and serious symptoms. Although no differences in self-reported health statuswere observed, health plans featuring cost sharing need careful monitoring for potential adverse health effects because of their propensity to reduce use of care that is considered necessary and appropriate. (Am J Public Health. 2001;91:1889–1894)
survey. Eligible subjects (English-speaking individuals 18 years or older) and their physicians were asked to complete a brief screening survey. Of 28257 patients who were approached, 20 222 (71.6%) agreed to participate; in the case of 18 974 (67.1%) of these patients, both the patient and his or her physician completed the forms. Through use of the data from the screening survey and an additional telephone interview, 3589 individuals with 1 or more chronic conditions (diabetes, hypertension, coronary heart disease, congestive heart failure,depression) were identified as potential subjects for a 4-year prospective cohort study. Of these patients, 2546 were randomly selected and agreed to participate. The included and excluded groups were similar in regard to sex, race/ethnicity, education, and annual income but differed in several other respects. In comparison with nonparticipants, participants were older (57.1 vs 54.2 years; P =.0001), more likely to be married (59% vs 52%; P = .002), slightly less likely to be employed (48% vs 52%; P = .08), and more likely to have a prepaid health plan (43% vs 31%; P = .001). The 2 groups had comparable comorbidity scores and Short Form-36 (SF-36)14 physical health status scores, but the study sample had slightly better SF-36 mental health scores (48.7 vs 46.3; P < .001).

METHODS
Study...