Who pays? Cost-sharing, tradeoffs, and the physicians' role in decision making.
Who pays? Cost-sharing, tradeoffs, and the physicians' role in decision making.
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谁付钱？
DOI：
10.1007/s11606-012-2119-0
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发表时间：
2012
影响因子：
5.7
通讯作者：
Pollack,CraigEvan
中科院分区：
文献类型：
--
作者：
Chen,Anders;Pollack,CraigEvan
I n this issue of JGIM, Galbraith and colleagues describe the impact of high deductible health plans (HDHPs) on delayed or foregone care amongst families with chronic medical conditions. 1 They find that families in HDHPs are more likely to delay or forego care, compared to those in traditional plans. Patients in health plans with high out-ofpocket costs and with limited resources must, at times, make real tradeoffs. These tradeoffs raise a number of important questions. When families forgo health care, what are the consequences? When healthcare is not sacrificed, what is? And what should be the role of primary care providers in helping patients and their families face these decisions? In the setting of the rapid uptake of high deductible health plans 2 and continued economic turbulence, the answers to these questions have become more urgent.The effects of HDHPs on health care utilization and outcomes are not well established. The RAND Health Insurance Experiment (HIE) in the 1970s suggested that increased cost-sharing generally reduced overall health care utilization and spending, and did not lead to worse health outcomes. This paved the way for insurance plans with higher cost-sharing, and in recent years, HDHPs. However, the effects of RAND’s experiment on the health of patients with chronic illnesses were less clear. 3, 4 Subsequent to the RAND experiment, a growing body of literature has demonstrated that for patients with chronic illnesses, such foregone care due to cost-sharing indeed may be detrimental. 5–11 Whether this was true during the RAND HIE and undetected, or whether this has emerged recently due to improved care for chronic illnesses remains unclear. 12 The specific data on HDHPs are coming to light. Research suggests that HDHPs tend to reduce low acuity ED visits and overall costs. 13, 14 However, it is uncertain whether early reductions will be sustained over time 15 and what the overall impact will be on health outcomes. Overall, the
