The effects of cost sharing on access to care among childless adults

Abstract

Objectives: To analyze the impact of public health insurance expansions and the use of enrollee cost sharing on insurance status and receipt of clinically indicated preventive screenings and physician services.

Data source: This study uses Behavioral Risk Factor Surveillance System (BRFSS) data from 1997 to 2007.

Study design: This study uses multivariate difference-in-difference logistic regression modeling of pooled cross-sectional time series data. The effect of the expansions on insurance status and access to care is identified by cross-state variation in program implementation, as well as cross-state and within-state variation in program eligibility criteria over time.

Principal findings: Childless adult expansions, regardless of cost-sharing levels, reduced uninsurance rates and decreased the likelihood that childless adults needed to see a physician but did not because of cost. Expansions with traditional public insurance cost-sharing requirements increased the use of preventive screenings, while expansions with increased cost-sharing requirements did not.

Conclusions: Cost-sharing requirements did not have an impact on the ability to see a physician when needed, but they played an important role in the utilization of preventive services. Expanding public health insurance to low-income, childless adults presents a promising policy opportunity, but there are trade-offs between the efficiencies obtained through increased cost sharing and the potential inefficiencies due to the lower use of preventive services.