Cost-sharing and the utilization of clinical preventive services

Am J Prev Med. 1999 Aug;17(2):127-33. doi: 10.1016/s0749-3797(99)00057-4.


Background: Little is known about the effect of different forms of patient cost-sharing on the utilization of clinical preventive services or if the effect varies by type of health plan.

Objectives: To assess empirically the relationships between the utilization of recommended preventive services and different forms of patient cost-sharing and how the effect is mediated by type of preventive service (counseling, blood pressure, Pap smear, mammogram), type of cost-sharing (deductibles/coinsurance, copayments), and type of health plan (HMO, PPO/indemnity plan).

Research design: Sixteen logit models were estimated to assess variation in receiving recommended preventive care as a function of cost-sharing within plan type.

Subjects: A sample of 10,872 employees, aged 18 to 64 years, of seven large companies served by 52 health plans with diverse cost-sharing arrangements who responded to the Pacific Business Group on Health, Health Plan Value Check Survey (response rate, 50.3%).

Measures: Receipt of recommended preventive care was based on the U.S. Preventive Services Task Force Guidelines. The effect of cost-sharing was measured as the percentage change in the probability of receiving recommended preventive care in the cost-sharing group compared to the non cost-sharing group.

Results: The negative effect of patient cost-sharing was greatest on preventive counseling in PPO/indemnity plans (-15%) and on mammograms in all health plan types (-9%-10%). The effect on Pap smears was negative (-8%-10%) for deductibles/coinsurance in PPO/indemnity plans and copayments in HMOs. The effect of cost-sharing on blood pressure was mixed. Deductibles/coinsurance had a greater negative effect than copayments.

Conclusions: Eliminating patient cost-sharing for selected preventive services may be a relatively easy and effective means of increasing utilization of recommended clinical preventive care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Blood Pressure Determination / economics
  • California
  • Cost Sharing / economics
  • Cost Sharing / methods*
  • Cost-Benefit Analysis
  • Data Collection
  • Female
  • Health Care Reform
  • Humans
  • Logistic Models
  • Male
  • Mammography / economics
  • Mammography / statistics & numerical data
  • Managed Care Programs / economics*
  • Managed Care Programs / standards
  • Middle Aged
  • Papanicolaou Test
  • Preventive Health Services / economics*
  • Preventive Health Services / statistics & numerical data*
  • Surveys and Questionnaires
  • Vaginal Smears / economics