Michael Chernew, Sarah Thomson and Laura Schang
S. Thomson, L. Schang, and M. E. Chernew, "Value-Based Cost Sharing in the United States and Elsewhere Can Increase Patients’ Use of High-Value Goods and Services," Health Affairs, April 2013 32(4):704–12.
Research suggests when making decisions about health care treatments, people have difficulty distinguishing high value from low value. As a result, across-the-board patient cost-sharing in the form of copayments and deductibles tends to reduce the use of both appropriate and inappropriate care in nearly equal amounts. Tiered cost-sharing systems, like those used by many U.S. payers for prescription drug coverage, offer greater promise to promote use of high-value care, as they require higher copayments for drugs deemed to be of lower value or cost-effectiveness.
Researchers reviewed efforts in the United States and several other member countries of the Organization for Economic Cooperation and Development (OECD) to encourage patients to use drugs, services, and preferred providers that offer better value than other options. These value-based cost-sharing approaches include:
The Commonwealth Fund–supported researchers found that although many OECD countries are using value-based approaches to steer patients toward more efficient and less costly care, use of such strategies is limited by a lack of information about the value of many health care interventions. The high cost of comparative effectiveness studies may deter countries from more broadly pursuing value-based policies.
Value-based cost-sharing can be an important tool for encouraging high-value health care. However, the authors caution that this approach requires careful design, implementation, and continuous evaluation.