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Eliminating out-of-pocket costs increases PCP visits, reduces ED use
Elimination of out-of-pocket expense for children’s primary care visits increased usage of primary care providers and decreased usage of emergency medicine providers, according to recent research in The Journal of Pediatrics.
“The current study demonstrates that using patient out-of-pocket costs for PCP office visits to incentivize greater use was associated with significant changes in behavior related to health services utilization and costs,” Martín-J. Sepúlveda, MD, FACP, senior executive adviser of Watson Health at IBM Corp. in Yorktown Heights, New York, and colleagues wrote. “The results add to the evidence base of the positive impact of accessible, affordable primary care for children.”
Martín-J. Sepúlveda
The researchers studied health care claims data for 25,950 children aged younger than 18 years, insured under an IBM plan that eliminated out-of-pocket costs for primary care. Study participants were matched to a control group using a propensity score matching process. The researchers estimated the effect of eliminating out-of-pocket costs on six health care services measures, including hospital admissions, hospital days, ED visits, PCP visits, specialist physician visits and prescription drug fills.
Study results showed that eliminating out-of-pocket costs increased visits to PCPs by 32 per 100 children, and decreased ED visits by five per 100 children (P < .01). Elimination of costs also was associated with a decline of 12 visits per 100 children in specialty physician visits. The researchers also found that eliminating out-of-pocket costs reduced the number of drug fills by 20 per 100 children, but did not affect medication adherence for three chronic conditions.
Furthermore, Sepúlveda and colleagues found that preventive care and receipt of vaccines for HPV, tetanus, pneumonia and influenza increased after out-of-pocket costs were eliminated (P < .05). Total health care costs per child were not significantly affected by the eliminated expenses.
“Although it had been hoped that the overall services utilization changes for the study group would have caused total health care costs to decline, greater value still accrued to the employer plan sponsor because their members received greater preventive services and well-child encounters, and avoided exposures to medications and EDs for the same total cost,” Sepúlveda and colleagues wrote. “If primary care is exempted from … out-of-pocket expenses, as some preventive services often are, reduced use of high-cost secondary services, improved delivery of preventive care, and other benefits are likely to accrue to children, youth and the health system overall.” – by David Costill
Disclosure: Sepúlveda is an employee of IBM Corp.
