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Patient Cost Sharing: How Much Is Too Much?

Patient Cost Sharing: How Much Is Too Much?. Sally Trude December 3, 2003. Patient Cost Sharing. Employer response to rising premiums Incremental increases from different levels Analysis of effect on out-of-pocket costs By income By health status. Actuarial Models of Cost-sharing.

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Patient Cost Sharing: How Much Is Too Much?

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  1. Patient Cost Sharing: How Much Is Too Much? Sally Trude December 3, 2003

  2. Patient Cost Sharing • Employer response to rising premiums • Incremental increases from different levels • Analysis of effect on out-of-pocket costs • By income • By health status

  3. Actuarial Models of Cost-sharing • Actuarial Research Corporation • Jim Mays and Monica Brenner • 1997 MEPS calibrated to reflect 2003 spending

  4. Spectrum of Cost-sharing Options 6 scenarios • 2 copayment options • Low copayment • High copayment • 4 coinsurance and deductible options • $100, 10% in network / 20% out of network • $500, 20% / 30% • $1000, 20% / 30% • $2500, 30% / 50%

  5. Overall Average Out-of-Pocket Costs Increase With Higher Cost Sharing

  6. Percent Exceeding $1500 Per Year Increase with High Cost Sharing

  7. Out-of-Pocket Costs Increase Most for Seriously Ill

  8. Percent Exceeding $1500 Highest for Seriously Ill

  9. Percent Exceeding 10% of Income Highest for Seriously Ill

  10. Highest Cost Sharing Raises Financial Burden

  11. Implications • Financial burden increases for seriously ill and low income workers. • Limits employers’ use of tool. • Need for refinements to target discretionary care. • Practitioner involvement required.

  12. John Bertko Presentation(click here)

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