Effects of increased patient cost sharing on socioeconomic disparities in health care
Authors
Chernew, Michael E.Gibson, Teresa B.
Yu-Isenberg, Kristina
Sokol, Michael C.
Rosen, Allison B.
Fendrick, A. Mark
UMass Chan Affiliations
Department of Quantitative Health SciencesDocument Type
Journal ArticlePublication Date
2008-04-30Keywords
Insurance, Health, ReimbursementPrescription Drugs
Cost Sharing
Healthcare Disparities
Biostatistics
Epidemiology
Health Services Research
Metadata
Show full item recordAbstract
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.Source
J Gen Intern Med. 2008 Aug;23(8):1131-6. Epub 2008 Apr 29. Link to article on publisher's siteDOI
10.1007/s11606-008-0614-0Permanent Link to this Item
http://hdl.handle.net/20.500.14038/47795PubMed ID
18443882Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1007/s11606-008-0614-0