Health Insurance,
Cost Sharing, Access, and Health Outcomes
(Links are for further information)
Employer-based insurance has been surveyed annually since 1999 to
follow
trends in coverage, benefits, costs, etc.: Kaiser
Family Foundation Annual Employer Health Benefits Survey
Foundation Resources
on Medicare Rx Drug Benefit provides links to Kaiser Foundation
reports on Medicare Part D.
"Paying for
Choice: The Cost Implications of Health Plan Options for People on
Medicare" by Rani Snyder, Thomas Rice, and Michelle Kitchman
Kaiser
Family Foundation
report:
Scope of coverage provided by supplemental insurance is
often a more important determinant of total out-of-pocket costs than
are premiums, but often difficult for consumers to assess and compare.
Even those with chronic illnesses and predictable service and equipment
needs would be challenged to project costs under alternative
supplemental insurance options, due
to formularies and coverage limits that are often difficult to decipher
prior to enrollment. (p. vi)
(A) healthy 65 year-old with . . . (few) health care needs . . . would
face up to a $9,000 difference in total spending depending on the plan
she chooses and where she lives. This cost difference alone reflects
over half the mean annual income of women ages 65 and older. (p.v)
"Health
Insurance Premiums and Cost-Sharing: Finding from the
Research on Low-Income Populations" by Julie Hudman and Molly
O'Malley 2003
Kaiser Family Foundation report & fact sheet.
"Historically, the Medicaid program has prohibited or sharply limited
premiums and cost-sharing because it serves a low-income population who
lack substantial resources to apply to out-of-pocket costs. However, as
publicly financed
health coverage programs, including the State Children's Health
Insurance
Program, have expanded to reach families with somewhat higher incomes,
family
contributions to premiums for coverage or cost sharing for services
have
come under renewed discussion." (p.1)
"A significant body of literature exists that examines the effect of
cost-sharing on various measures of access to care, utilization of
services, and health outcomes. Most, but not all, studies reached the
same conclusion -- that
cost-sharing reduces utilization, especially primary care and
preventive
services . . . A handful of studies. however. did not find that
cost-sharing
significantly impacted utilization for the general population . . . or
health
status and outcomes." (p.1)
"Cost-sharing has a disproportionate impact on low-income people. A
number of the research studies have used data from the RAND Health
Insurance Experiment (HIE) -- a randomized, controlled experiment
supported by the federal government in the 1970s that remains the most
comprehensive, rigorous study of cost-sharing, health care utilization
and outcomes that exists. Analysis of RAND data
showed that low-income children in cost-sharing plans had only a 56%
likelihood
(85% for higher-income children) of receiving highly effective care for
acute
conditions relative to those with no cost-sharing . . . Similarly,
low-income
adults in cost-sharing plans had a 59% likelihood of receiving highly
effective
care relative to those with no cost-sharing. Higher income adults in
cost-sharing plans fared better -- they had a 71% likelihood of
receiving highly effective care." (fact sheet)
Utah is one
of several states granted Section 1115 waivers to experiment with adjustments in
cost-sharing, benefit plans, and eligibility. The Kaiser Family
Foundation is following these waivers with analyses and fact sheets.