Effect of Switching to a High-Deductible Health Plan on Use of Chronic Medications

Reiss, Sheila K.; Ross‐Degnan, Dennis; Zhang, Fang; Soumerai, Stephen B.; Zaslavsky, Alan M.; Wharam, J. Frank

doi:10.1111/j.1475-6773.2011.01252.x

Cited by 32 publications

(33 citation statements)

References 37 publications

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“…Between 2006 and 2011, the proportion of privately insured patients facing a deductible greater than $1000 increased from 10% to 31%. 9 Few diagnostic laboratory tests are exempt from these deductibles. The absence of information about laboratory test costs for patients and clinicians as well as the effect of these costs on clinical practice and care have been issues of concern for many years.…”

Section: Discussionmentioning

confidence: 99%

Primary Care Physicians' Challenges in Ordering Clinical Laboratory Tests and Interpreting Results

Hickner

Thompson

Wilkinson

et al. 2014

The Journal of the American Board of Family Medicine

128

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Background:The number and complexity of clinical laboratory tests is rapidly expanding, presenting primary care physicians with challenges in accurately, efficiently, and safely ordering and interpreting diagnostic tests. The objective of this study was to identify challenges primary care physicians face related to diagnostic laboratory testing and solutions they believe are helpful and available to them.Methods: In this study, sponsored by the Centers for Disease Control and Prevention, a random sample of general internal medicine and family medicine physicians from the American Medical Association Masterfile were surveyed in 2011.Results: 1768 physicians (5.6%) responded to the survey. Physicians reported ordering diagnostic laboratory tests for an average of 31.4% of patient encounters per week. They reported uncertainty about ordering tests in 14.7% and uncertainty in interpreting results in 8.3% of these diagnostic encounters. The most common problematic challenges in ordering tests were related to the cost to patients and insurance coverage restrictions. Other challenges included different names for the same test, tests not available except as part of a test panel, and different tests included in panels with the same names. The most common problematic challenges in interpreting and using test results were not receiving the results and confusing report formats. Respondents endorsed a variety of information technology and decision support solutions to improve test selection and results interpretation, but these solutions were not widely available at the time of the survey. Physicians infrequently sought assistance or consultation from laboratory professionals but valued these consultations when they occurred.Conclusions: Primary care physicians routinely experience uncertainty and challenges in ordering and interpreting diagnostic laboratory tests. With more than 500 million primary care patient visits per year, the level of uncertainty reported in this study potentially affects 23 million patients per year and raises significant concerns about the safe and efficient use of laboratory testing resources. Improvement in information technology and clinical decision support systems and quick access to laboratory consultations may reduce physicians' uncertainty and mitigate these challenges. (J Am Board Fam Med 2014;27:268-274.)

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Section: Discussionmentioning

confidence: 99%

Primary Care Physicians' Challenges in Ordering Clinical Laboratory Tests and Interpreting Results

Hickner

Thompson

Wilkinson

et al. 2014

The Journal of the American Board of Family Medicine

128

View full text Add to dashboard Cite

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“…From 2006 to 2010 the percentage of employees covered by HDHPs with a deductible of at least $1000, increased from 10 percent to 27 percent [23]. In 2010, average deductibles for commercial health insurance plans ranged from $601 to $1903 for individuals and $1321 to $3780 for families [23], though the maximum out of pocket burden in 2015 is capped at $6,450 for self-only coverage or $12,900 for family coverage (IRS.…”

Section: The Underinsured: High Deductible Health Plansmentioning

confidence: 99%

“…For the past few decades there has been research around utilization of healthcare services with patients facing high cost sharing responsibility. The RAND Health Insurance Experiment of 1971 -1986 found that patients who are facing high-level cost-sharing reduced overall utilization by approximately 33 percent and total spending by about 30 percent [23].…”

Section: The Underinsured: High Deductible Health Plansmentioning

confidence: 99%

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The Financial Impact of Uncompensated Care in the Emergency Department

Treister¹

2017

IJEEE

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Prior to 1986, emergency department staff was both morally and ethically obligated to provide care that included the stabilization and treatment of all patients who presented to the emergency department, regardless of their ability to pay. In 1986, this moral and ethical obligation became federal law with the passage of the Emergency Medical Treatment and Labor Act (EMTALA), which required any patient coming to an emergency department be stabilized and treated regardless of their insurance status or ability to pay [1] [2]. Hospital emergency departments are a critical entry point into the American health care system. The patient population is a combination of the privately insured, including high deductible health plans, the uninsured, and the underinsured. Although emergency treatment is covered under EMTALA, hospitals are left to deal with the bills accumulated from non-emergent daily medical care. The increase in volume places tremendous burden on hospital emergency departments, with high overhead and fixed costs. Many facilities cannot keep up with costs and are forced into bankruptcy, leading to overcrowding in nearby hospitals. More thought must be placed on how hospitals can bear the burden of uncompensated care. Access to care is not enough; it's crucial that care be affordable. Addressing uncompensated care in the emergency department can be done successfully. The staff is proficient in saving lives, now they must learn to put the same effort into saving money.

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“…32 In addition, VBID has been incorporated into HDHPs, many of which now waive the deductible for selected types of preventive care (e.g., breast and cervical cancer screenings, and well-child visits) 33 and other treatments perceived to be of high value (e.g., medications for chronic conditions). 34 While VBID programs may consider CEAs only informally when identifying high-value care, they focus on clinical areas with the greatest potential to improve health outcomes and/or constrain costs, including the treatment of chronic illnesses (e.g., diabetes and antihypertensive medications) and secondary disease prevention (e.g., statins that lower cholesterol). 35 Early evidence suggests that such programs have been successful at meeting this potential.…”

Section: B Demand-side Initiativesmentioning

confidence: 99%

The Economics of Healthcare Rationing

Frakes

Frank²,

Rozema

2015

Oxford Handbooks Online

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This article examines the economics of healthcare rationing. We begin with an overview of the various dimensions across which healthcare rationing operates, or at least has the potential to operate, in the first place. We then describe the types of economic analyses used in healthcare rationing decision-making, with particular reference to costbenefit analysis and cost-effectiveness analysis. We also discuss healthcare rationing in practice, such as how economic analyses inform decisions regarding which services to cover, and conclude by discussing various practical and conceptual challenges that may arise with economic analyses and that span both economics and ethics.Keywords: economics, healthcare rationing, healthcare, economic analyses, decisionmaking, cost-benefit analysis, cost-effectiveness analysis, ethics Another article in this volume discussed various ethical considerations surrounding the rationing of healthcare. Any study of the rationing of goods and services, however, would be incomplete without the consideration of economic analysis. The need for rationing in the first instance arguably encapsulates the essence of economics itself. Though many definitions abound, economics is often described as the study of how individuals and agents of society allocate scarce resources among competing desires. Clearly, individuals cannot each acquire and consume all of the products and services that they want without limitation. Many, if not all, goods and services must be "rationed" in some manner. In this article, we provide a brief overview of healthcare rationing through the lens of economic analysis.At the outset, it is worth saying a bit about the term "rationing," which is often thrown around rather loosely by the media. In the broadest sense, rationing can be interpreted as any means of limiting individuals' consumption of products and services.This perspective implies that prices can ration. After all, those unwilling to pay the price for a particular good or service may be excluded from consuming or receiving it.Moreover, the first fundamental welfare theorem of economics holds that price mechanisms in competitive markets will, under a restrictive set of assumptions, perform this necessary allocation of resources in a Pareto-efficient manner-that is, it would be impossible to reallocate resources so as to make someone better off without making another worse off. Some economists, however, have uneasy feelings about referring to the free market's price mechanism as a means of rationing. Rather, "rationing" is often used as a term of art by many economists to explain any number of ways that policymakers and industry participants influence who consumes what healthcare services, excluding from this definition the distribution of goods and services via market-clearing forces. For the purposes of this article, we largely refer to rationing in this more limited context.If prices theoretically generate Pareto-efficient outcomes, one may wonder why nonprice means of rationing are even warranted in the ...

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Effect of Switching to a High-Deductible Health Plan on Use of Chronic Medications

Abstract: Switching to an HDHP that included modest drug copayments did not change medication availability or reduce use of essential medications for three common chronic illnesses.

Cited by 32 publications

References 37 publications

Primary Care Physicians' Challenges in Ordering Clinical Laboratory Tests and Interpreting Results

Primary Care Physicians' Challenges in Ordering Clinical Laboratory Tests and Interpreting Results

The Financial Impact of Uncompensated Care in the Emergency Department

The Economics of Healthcare Rationing

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