کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
---|---|---|---|---|
6219367 | 1607426 | 2016 | 6 صفحه PDF | دانلود رایگان |
ObjectiveTo evaluate the impact of a value-based insurance design for primary care among children.Study designA retrospective analysis of health care claims data on 25â950 children (<18Â years of age) was conducted. Individuals were enrolled in a large employer's health plans when zero out-of-pocket cost for primary care physician visits was implemented. A rigorous propensity score matching process was used to generate a control group of equal size from a database of other employer-sponsored insurees. Multivariate difference-in-differences models estimated the effect of zero out-of-pocket cost on 21 health services and cost outcomes 24Â months after intervention.ResultsZero out-of-pocket cost for primary care was associated with significant increases (PÂ <Â .01) in primary care physician visits (+32 per 100 children), as well as decreases in emergency department (â5 per 100 children) and specialist physician visits (â12 per 100 children). The number of prescription drug fills also declined (â20 per 100 children), yet medication adherence for 3 chronic conditions was unaffected. The receipt of well child visits and 4 recommended vaccinations were all significantly (PÂ <Â .05) greater under the new plan design feature. Employer costs for primary care increased significantly (PÂ <Â .01) in association with greater utilization ($29 per child), but specialist visit costs declined (â$12 per child) and total health care costs per child did not exhibit a statistically significant increase.ConclusionThis novel application of value-based insurance design warrants broader deployment and assessment of its longer term outcomes. As with recommended preventive services, policymakers should consider exempting primary care from health insurance cost-sharing.
Journal: The Journal of Pediatrics - Volume 175, August 2016, Pages 195-200