What Might Be the Health Cost of Changes in Benefit Design?

In case you hadn’t noticed, employers and insurers are engaged in a headlong process of transferring health care costs to the insured employees. The term “price sensitivity” also is used a lot, the idea being that you might not push for that medically-optional, expensive drug, procedure or test. But while there’s logic and evidence that price sensitivity can lower immediate costs to employers, we need information about other effects of shifting costs directly to consumers (who, of course, pay those costs already, albeit indirectly, in the form of lower wages, economists tell us).

So when I read this interesting study in JAMA (May 19, 2004,) by Dana P. Goldman, PhD, et al, of Rand, I wasn’t too surprised. I will, of course, oversimplify: Raise copayments for drugs and some people will get fewer doses than they need — really need.

“When we examined the chronically ill population receiving routine care, a group of patients who are most likely to benefit from drug treatment, we still found that doubling copayments is associated with reductions in drug use of 8% to 23%,” the authors write. We’re talking dyslipidemia and diabetes, especially, and you know what noncompliance can mean for those patients.

Happily, these patients showed less of a drop in annual days supplied than did patients who used prescription antihistamines and NSAIDs. Perhaps people are smarter than I had suspected, though the success of “reality” TV makes me wonder.

We need to pay attention to the health effects of benefit changes and avoid jumping on the cost-shifting bandwagon until we know more. Or do you physicians and pharmacists who constitute the great majority of my readers disagree?


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