Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2014
Can value-based insurance impose societal costs?
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Koenig Lane, Dall Timothy M, Ruiz David, Saavoss Josh, Tongue John
Аннотация
BACKGROUND: Among policy alternatives considered to reduce health care costs and improve outcomes, value-based insurance design (VBID) has emerged as a promising option. Most applications of VBID, however, have not used higher cost sharing to discourage specific services. In April 2011, the state of Oregon introduced a policy for public employees that required additional cost sharing for high-cost procedures such as total knee arthroplasty (TKA).
OBJECTIVES: Our objectives were to estimate the societal impact of higher co-pays for TKA using Oregon as a case study and building on recent work demonstrating the effects of knee osteoarthritis and surgical treatment on employment and disability outcomes.
METHODS: We used a Markov model to estimate the societal impact in terms of quality of life, direct costs, and indirect costs of higher co-pays for TKA using Oregon as a case study.
RESULTS: We found that TKA for a working population can generate societal benefits that offset the direct medical costs of the procedure. Delay in receiving surgical care, because of higher co-payment or other reasons, reduced the societal savings from TKA.
CONCLUSIONS: We conclude that payers moving toward value-based cost sharing should consider consequences beyond direct medical expenses.
OBJECTIVES: Our objectives were to estimate the societal impact of higher co-pays for TKA using Oregon as a case study and building on recent work demonstrating the effects of knee osteoarthritis and surgical treatment on employment and disability outcomes.
METHODS: We used a Markov model to estimate the societal impact in terms of quality of life, direct costs, and indirect costs of higher co-pays for TKA using Oregon as a case study.
RESULTS: We found that TKA for a working population can generate societal benefits that offset the direct medical costs of the procedure. Delay in receiving surgical care, because of higher co-payment or other reasons, reduced the societal savings from TKA.
CONCLUSIONS: We conclude that payers moving toward value-based cost sharing should consider consequences beyond direct medical expenses.