Effects of Increased Patient Cost Sharing on Socioeconomic Disparities in Health Care
- 29 April 2008
- journal article
- research article
- Published by Springer Science and Business Media LLC in Journal of General Internal Medicine
- Vol. 23 (8), 1131-1136
- https://doi.org/10.1007/s11606-008-0614-0
Abstract
Background Increasing patient cost sharing is a commonly employed mechanism to contain health care expenditures. Objective To explore whether the impact of increases in prescription drug copayments differs between high- and low-income areas. Design Using a database of 6 million enrollees with employer-sponsored health insurance, econometric models were used to examine the relationship between changes in drug copayments and adherence with medications for the treatment of diabetes mellitus (DM) and congestive heart failure (CHF). Subjects Individuals 18 years of age and older meeting prespecified diagnostic criteria for DM or CHF were included. Measurements Median household income in the patient’s ZIP code of residence from the 2000 Census was used as the measure of income. Adherence was measured by medication possession ratio: the proportion of days on which a patient had a medication available. Results Patients in low-income areas were more sensitive to copayment changes than patients in high- or middle-income areas. The relationship between income and price sensitivity was particularly strong for CHF patients. Above the lowest income category, price responsiveness to copayment rates was not consistently related to income. Conclusions The relationship between medication adherence and income may account for a portion of the observed disparities in health across socioeconomic groups. Rising copayments may worsen disparities and adversely affect health, particularly among patients living in low-income areas.Keywords
This publication has 29 references indexed in Scilit:
- Prescription Drug Cost SharingJAMA, 2007
- Effect of Increased Cost-Sharing on Oral Hypoglycemic Use in Five Managed Care OrganizationsMedical Care, 2005
- A Copayment Increase for Prescription Drugs: The Long-Term and Short-Term Effects on Use and ExpendituresINQUIRY: The Journal of Health Care Organization, Provision, and Financing, 2005
- Avoidance Of Health Care Services Because Of Cost: Impact Of The Medicare Savings ProgramHealth Affairs, 2005
- The effects of cost-sharing on essential drug prescriptions, utilization of medical care and outcomes after acute myocardial infarction in elderly patients.2002
- Long-term Persistence in Use of Statin Therapy in Elderly PatientsJAMA, 2002
- Zip Code Caveat: Bias Due to Spatiotemporal Mismatches Between Zip Codes and US Census–Defined Geographic Areas—The Public Health Disparities Geocoding ProjectAmerican Journal of Public Health, 2002
- Impact of reference-based pricing for angiotensin-converting enzyme inhibitors on drug utilization.2002
- A benefit-based copay for prescription drugs: patient contribution based on total benefits, not drug acquisition cost.2001
- Adverse Events Associated With Prescription Drug Cost-Sharing Among Poor and Elderly PersonsJAMA, 2001