Trends in patient cost sharing for clinical services used as quality indicators

Abstract

Background: Patient copayments for all medical services have increased dramatically. There are few data available regarding how copayments have changed for services commonly considered to be quality indicators.

Objective: Describe the relative change in copayments for services used as quality indicators and interventions subject to programs to control utilization.

Design: A large claims database was used to assess copayment changes from 2001 to 2006 for selected drug and non-drug services in patient cohorts with specific chronic diseases.

Subjects: Approximately 5 million commercially-insured individuals enrolled in a variety of fee-for-service and capitated health plans.

Measurements: Copayment trends were calculated as the change in the average amount paid per unit service from 2001 to 2006.

Results: Out-of-pocket payments for services targeted by quality improvement initiatives increased substantially [>50%] and in a similar magnitude to interventions subject to programs to control their use. For prescription drugs, the trend was driven more by copayment increases for branded medications [$10 per prescription] than for generic drugs [$2 per prescription]. Copayments for non-drug preventive services rose modestly.

Conclusions: Benefit designers should consider reversing the trend of copayment increases for services considered to be indicators of high quality care.