IDEAS home Printed from https://ideas.repec.org/p/nbr/nberwo/22875.html
   My bibliography  Save this paper

The Impact of Increased Cost-sharing on Utilization of Low Value Services: Evidence from the State of Oregon

Author

Listed:
  • Jonathan Gruber
  • Johanna Catherine Maclean
  • Bill J. Wright
  • Eric S. Wilkinson
  • Kevin Volpp

Abstract

In this study we examine the impact of a value-based insurance design (V-BID) program implemented between 2010 and 2013 at a large public employer in the state of Oregon. The program substantially increased cost-sharing, specifically copayments and coinsurance, for several healthcare services believed to be of low value and overused (sleep studies, endoscopies, advanced imaging, and surgeries). Using a differences-in-differences design coupled with granular, administrative health insurance claims data, we estimate the change in low value healthcare service utilization among beneficiaries before and after program implementation relative to a comparison group of beneficiaries who were not exposed to the V-BID. Our findings suggest that the V-BID significantly reduced utilization of targeted services. These findings have important implications for both public and private healthcare policies as V-BID principles are rapidly proliferating in healthcare markets.

Suggested Citation

  • Jonathan Gruber & Johanna Catherine Maclean & Bill J. Wright & Eric S. Wilkinson & Kevin Volpp, 2016. "The Impact of Increased Cost-sharing on Utilization of Low Value Services: Evidence from the State of Oregon," NBER Working Papers 22875, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:22875
    Note: EH
    as

    Download full text from publisher

    File URL: http://www.nber.org/papers/w22875.pdf
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. Zarek C. Brot-Goldberg & Amitabh Chandra & Benjamin R. Handel & Jonathan T. Kolstad, 2017. "What does a Deductible Do? The Impact of Cost-Sharing on Health Care Prices, Quantities, and Spending Dynamics," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 132(3), pages 1261-1318.
    2. Haviland, Amelia M. & Eisenberg, Matthew D. & Mehrotra, Ateev & Huckfeldt, Peter J. & Sood, Neeraj, 2016. "Do “Consumer-Directed” health plans bend the cost curve over time?," Journal of Health Economics, Elsevier, vol. 46(C), pages 33-51.
    3. Edward C. Norton & Hua Wang & Chunrong Ai, 2004. "Computing interaction effects and standard errors in logit and probit models," Stata Journal, StataCorp LP, vol. 4(2), pages 154-167, June.
    4. A. Colin Cameron & Douglas L. Miller, 2015. "A Practitioner’s Guide to Cluster-Robust Inference," Journal of Human Resources, University of Wisconsin Press, vol. 50(2), pages 317-372.
    5. Ai, Chunrong & Norton, Edward C., 2003. "Interaction terms in logit and probit models," Economics Letters, Elsevier, vol. 80(1), pages 123-129, July.
    6. Katherine Baicker & Dana Goldman, 2011. "Patient Cost-Sharing and Healthcare Spending Growth," Journal of Economic Perspectives, American Economic Association, vol. 25(2), pages 47-68, Spring.
    7. Justin Wolfers, 2006. "Did Unilateral Divorce Laws Raise Divorce Rates? A Reconciliation and New Results," American Economic Review, American Economic Association, vol. 96(5), pages 1802-1820, December.
    8. Peter J. Huckfeldt & Amelia Haviland & Ateev Mehrotra & Zachary Wagner & Neeraj Sood, 2015. "Patient Responses to Incentives in Consumer-directed Health Plans: Evidence from Pharmaceuticals," NBER Working Papers 20927, National Bureau of Economic Research, Inc.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Natalia Serna, 2021. "Cost sharing and the demand for health services in a regulated market," Health Economics, John Wiley & Sons, Ltd., vol. 30(6), pages 1259-1275, June.
    2. Elizabeth D. Brouwer & Anirban Basu & Kai Yeung, 2019. "Adoption of Cost Effectiveness-Driven Value-Based Formularies in Private Health Insurance from 2010 to 2013," PharmacoEconomics, Springer, vol. 37(10), pages 1287-1300, October.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Jonathan Gruber & Johanna Catherine Maclean & Bill Wright & Eric Wilkinson & Kevin G. Volpp, 2020. "The effect of increased cost‐sharing on low‐value service use," Health Economics, John Wiley & Sons, Ltd., vol. 29(10), pages 1180-1201, October.
    2. Eisenberg, Matthew D. & Haviland, Amelia M. & Mehrotra, Ateev & Huckfeldt, Peter J. & Sood, Neeraj, 2017. "The long term effects of “Consumer-Directed” health plans on preventive care use," Journal of Health Economics, Elsevier, vol. 55(C), pages 61-75.
    3. Thomas C. Omer & shelley@unl.edu & Frances M. Tice, 2020. "Do Director Networks Matter for Financial Reporting Quality? Evidence from Audit Committee Connectedness and Restatements," Management Science, INFORMS, vol. 66(8), pages 3361-3388, August.
    4. Ackley, Calvin A., 2022. "Tiered cost sharing and health care demand," Journal of Health Economics, Elsevier, vol. 85(C).
    5. Zvonimir Bašić & Parampreet C. Bindra & Daniela Glätzle-Rützler & Angelo Romano & Matthias Sutter & Claudia Zoller, 2021. "The Roots of Cooperation," ECONtribute Discussion Papers Series 097, University of Bonn and University of Cologne, Germany.
    6. Sakaue, Katsuki, 2018. "Informal fee charge and school choice under a free primary education policy: Panel data evidence from rural Uganda," International Journal of Educational Development, Elsevier, vol. 62(C), pages 112-127.
    7. Carolin Bock & Maximilian Schmidt, 2015. "Should I stay, or should I go? – How fund dynamics influence venture capital exit decisions," Review of Financial Economics, John Wiley & Sons, vol. 27(1), pages 68-82, November.
    8. Chenxi Zhou & Jinhong Xie & Qi Wang, 2016. "Failure to Complete Cross-Border M&As: “To” vs. “From” Emerging Markets," Journal of International Business Studies, Palgrave Macmillan;Academy of International Business, vol. 47(9), pages 1077-1105, December.
    9. Janus, Thorsten & Riera-Crichton, Daniel, 2015. "Economic shocks, civil war and ethnicity," Journal of Development Economics, Elsevier, vol. 115(C), pages 32-44.
    10. Egon Franck & Erwin Verbeek & Stephan Nüesch, 2011. "Sentimental Preferences and the Organizational Regime of Betting Markets," Southern Economic Journal, John Wiley & Sons, vol. 78(2), pages 502-518, October.
    11. Zaporozhets, Vera & García-Valiñas, María & Kurz, Sascha, 2016. "Key drivers of EU budget allocation: Does power matter?," European Journal of Political Economy, Elsevier, vol. 43(C), pages 57-70.
    12. Susanne Prantl & Alexandra Spitz‐Oener, 2009. "How does entry regulation influence entry into self‐employment and occupational mobility?1," The Economics of Transition, The European Bank for Reconstruction and Development, vol. 17(4), pages 769-802, October.
    13. Chevassus-Lozza, Emmanuelle & Gaigné, Carl & Le Mener, Léo, 2013. "Does input trade liberalization boost downstream firms' exports? Theory and firm-level evidence," Journal of International Economics, Elsevier, vol. 90(2), pages 391-402.
    14. Dienes, Christian, 2015. "Actions and intentions to pay for climate change mitigation: Environmental concern and the role of economic factors," Ecological Economics, Elsevier, vol. 109(C), pages 122-129.
    15. Carpenter, Christopher S. & Churchill, Brandyn F. & Marcus, Michelle, 2023. "Bad lighting: Effects of youth indoor tanning prohibitions," Journal of Health Economics, Elsevier, vol. 88(C).
    16. Apouey, Bénédicte & Geoffard, Pierre-Yves, 2013. "Family income and child health in the UK," Journal of Health Economics, Elsevier, vol. 32(4), pages 715-727.
    17. Joachim Wagner & John P. Weche Gelübcke, 2016. "Risk or Resilience? The Role of Trade Integration and Foreign Ownership for the Survival of German Enterprises during the Crisis 2008–2010," World Scientific Book Chapters, in: Microeconometrics of International Trade, chapter 11, pages 369-397, World Scientific Publishing Co. Pte. Ltd..
    18. Cheng, Zhiming & Guo, Wei & Hayward, Mathew & Smyth, Russell & Wang, Haining, 2021. "Childhood adversity and the propensity for entrepreneurship: A quasi-experimental study of the Great Chinese Famine," Journal of Business Venturing, Elsevier, vol. 36(1).
    19. Heather Brown & Marjon van der Pol, 2014. "The Role Of Time Preferences In The Intergenerational Transfer Of Smoking," Health Economics, John Wiley & Sons, Ltd., vol. 23(12), pages 1493-1501, December.
    20. Deb, Partha & Gangaram, Anjelica & Khajavi, Hoda Nouri, 2021. "The impact of the State Innovation Models Initiative on population health," Economics & Human Biology, Elsevier, vol. 42(C).

    More about this item

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:nbr:nberwo:22875. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: the person in charge (email available below). General contact details of provider: https://edirc.repec.org/data/nberrus.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.