Along with increased spending on physician services, expanded coverage of outpatient physician visits contributed to higher spending on advanced imaging, diagnostic tests, minor procedures and prescription drugs, according to a new study from the nonprofit, nonpartisan National Institute for Health Care Reform (NIHCR).
Health insurance benefit structures, particularly cost–sharing amounts, can either encourage or discourage patients from seeking care. The goal is to strike the right balance so out–of–pocket costs don’t discourage people from getting needed care but do prompt them to consider costs before seeking discretionary care.
In 2011, contracts between the International Union, UAW, and Fiat Chrysler, Ford and General Motors significantly changed the structure of autoworker health benefits. Generally, coverage of outpatient physician visits was expanded while additional cost sharing was imposed for emergency department visits unless the patient is admitted to the hospital.
The study explores the impact of the autoworker health benefit changes on spending and utilization, providing insights into how benefit structures affect access and costs. Generally, lower patient cost sharing for physician visits resulted in substantially higher overall spending, both as a result of more physician visits as well as increased diagnostic services and procedures. However, higher cost sharing did not significantly decrease emergency department visits or expenditures.
The study findings are detailed in a new NIHCR Research Brief—Balancing Access and Costs: Health Benefit Structures for Privately Insured People—available here and written by James D. Reschovsky, Ph.D., a senior fellow at Mathematica Policy Research; Kara Contreary, Ph.D., a researcher at Mathematica Policy Research; and Joel V. Smith, Ph.D., a senior analytic solutions architect at Mathematica Policy Research.
The National Institute for Health Care Reform (NIHCR) is a nonpartisan, nonprofit 501(c)(3) organization created by the International Union, UAW; Chrysler Group LLC; Ford Motor Company; and General Motors. Between 2009 and 2013, NIHCR contracted with the Center for Studying Health System Change (HSC) to conduct high-quality, objective research and policy analyses of the organization, financing and delivery of health care in the United States. HSC ceased operations on Dec. 31, 2013, after merging with Mathematica Policy Research, which assumed the HSC contract to complete NIHCR projects.