IDEAS home Printed from https://ideas.repec.org/a/wly/hlthec/v29y2020i10p1180-1201.html
   My bibliography  Save this article

The effect of increased cost‐sharing on low‐value service use

Author

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

Abstract

We examine the effect of a value‐based insurance design (VBID) program implemented at a large public employer in the state of Oregon. The program substantially increased cost‐sharing for several healthcare services likely to be of low value for most patients: diagnostic services (e.g., imaging services) and surgeries (e.g., spinal surgeries for pain). Using a difference‐in‐differences design coupled with granular, administrative health insurance claims data over the period 2008–2012, we estimate the change in low‐value service use among beneficiaries before and after program implementation relative to a comparison group not exposed to the VBID. Our findings suggest that the VBID significantly reduced the use of targeted services, with an implied elasticity of demand of −0.22. We find no evidence that the VBID led to substitution to non‐targeted services or increased overall healthcare costs. However, we also observe no evidence that the program led to cost‐savings.

Suggested Citation

  • 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.
    • Handle: RePEc:wly:hlthec:v:29:y:2020:i:10:p:1180-1201
    DOI: 10.1002/hec.4127
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/hec.4127
    Download Restriction: no
    File URL: https://libkey.io/10.1002/hec.4127?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access 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, Oxford University Press, vol. 132(3), pages 1261-1318.
    2. Alberto Abadie & Javier Gardeazabal, 2003. "The Economic Costs of Conflict: A Case Study of the Basque Country," American Economic Review, American Economic Association, vol. 93(1), pages 113-132, March.
    3. 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.
    4. Joshua D. Angrist & Jörn-Steffen Pischke, 2009. "Mostly Harmless Econometrics: An Empiricist's Companion," Economics Books, Princeton University Press, edition 1, number 8769.
    5. 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.
    6. Kosali Simon & Aparna Soni & John Cawley, 2017. "The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 36(2), pages 390-417, March.
    7. David H. Autor, 2003. "Outsourcing at Will: The Contribution of Unjust Dismissal Doctrine to the Growth of Employment Outsourcing," Journal of Labor Economics, University of Chicago Press, vol. 21(1), pages 1-42, January.
    8. Gundula Krack, 2019. "How to make value-based health insurance designs more effective? A systematic review and meta-analysis," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(6), pages 841-856, August.
    9. Lauren Hersch Nicholas & Johanna Catherine Maclean, 2019. "The Effect of Medical Marijuana Laws on the Health and Labor Supply of Older Adults: Evidence from the Health and Retirement Study," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 38(2), pages 455-480, March.
    10. Katherine Baicker & Sendhil Mullainathan & Joshua Schwartzstein, 2015. "Behavioral Hazard in Health Insurance," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 130(4), pages 1623-1667.
    11. 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.
    12. Keshar M. Ghimire & Johanna Catherine Maclean, 2020. "Medical marijuana and workers' compensation claiming," Health Economics, John Wiley & Sons, Ltd., vol. 29(4), pages 419-434, April.
    13. Keeler, Emmett B. & Rolph, John E., 1988. "The demand for episodes of treatment in the health insurance experiment," Journal of Health Economics, Elsevier, vol. 7(4), pages 337-367, December.
    14. Stefan Boes & Joachim Marti & Johanna Catherine Maclean, 2015. "The Impact of Smoking Bans on Smoking and Consumer Behavior: Quasi‐Experimental Evidence from Switzerland," Health Economics, John Wiley & Sons, Ltd., vol. 24(11), pages 1502-1516, November.
    15. David Powell & Rosalie Liccardo Pacula, 2021. "The Evolving Consequences of OxyContin Reformulation on Drug Overdoses," American Journal of Health Economics, University of Chicago Press, vol. 7(1), pages 41-67.
    16. Jonathan Gruber & Benjamin D. Sommers, 2020. "Fiscal Federalism and the Budget Impacts of the Affordable Care Act's Medicaid Expansion," NBER Working Papers 26862, National Bureau of Economic Research, Inc.
    Full references (including those not matched with items on IDEAS)

    Citations

    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 12th October 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-10-12 11:00:03

    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 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.
    2. Johanna Catherine Maclean & Michael F. Pesko & Steven C. Hill, 2017. "The Effect of Insurance Expansions on Smoking Cessation Medication Prescriptions: Evidence from ACA Medicaid Expansions," NBER Working Papers 23450, National Bureau of Economic Research, Inc.
    3. Johanna Catherine Maclean & Benjamin L. Cook & Nicholas Carson & Michael F. Pesko, 2017. "Public Insurance and Psychotropic Prescription Medications for Mental Illness," NBER Working Papers 23760, National Bureau of Economic Research, Inc.
    4. Johanna Catherine Maclean & Brendan Saloner, 2019. "The Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 38(2), pages 366-393, March.
    5. Johanna Catherine Maclean & Brendan Saloner, 2018. "Substance Use Treatment Provider Behavior and Healthcare Reform: Evidence from Massachusetts," Health Economics, John Wiley & Sons, Ltd., vol. 27(1), pages 76-101, January.
    6. Alexander S. Skorobogatov, 2021. "The effect of alcohol sales restrictions on alcohol poisoning mortality: Evidence from Russia," Health Economics, John Wiley & Sons, Ltd., vol. 30(6), pages 1417-1442, June.
    7. 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.
    8. Boerner, Lars & Rubin, Jared & Severgnini, Battista, 2021. "A time to print, a time to reform," European Economic Review, Elsevier, vol. 138(C).
    9. Kurt Lavetti & Thomas DeLeire & Nicolas R. Ziebarth, 2023. "How do low‐income enrollees in the Affordable Care Act marketplaces respond to cost‐sharing?," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 90(1), pages 155-183, March.
    10. Bruno Ferman & Cristine Pinto, 2019. "Inference in Differences-in-Differences with Few Treated Groups and Heteroskedasticity," The Review of Economics and Statistics, MIT Press, vol. 101(3), pages 452-467, July.
    11. Nicolas R. Ziebarth, 2018. "Social Insurance and Health," Contributions to Economic Analysis, in: Health Econometrics, volume 127, pages 57-84, Emerald Group Publishing Limited.
    12. Maclean, Johanna Catherine & Tello-Trillo, Sebastian & Webber, Douglas, 2023. "Losing insurance and psychiatric hospitalizations," Journal of Economic Behavior & Organization, Elsevier, vol. 205(C), pages 508-527.
    13. Taylor K. Odle, 2022. "Free to Spend? Institutional Autonomy and Expenditures on Executive Compensation, Faculty Salaries, and Research Activities," Research in Higher Education, Springer;Association for Institutional Research, vol. 63(1), pages 1-32, February.
    14. Francesca Caselli, 2017. "Did the Exchange Rate Floor Prevent Deflation in the Czech Republic?," Review of Economics and Institutions, Università di Perugia, vol. 8(2).
    15. Hernæs, Øystein, 2018. "Activation against absenteeism – Evidence from a sickness insurance reform in Norway," Journal of Health Economics, Elsevier, vol. 62(C), pages 60-68.
    16. Emmanuel Nshakira-Rukundo & Essa Chanie Mussa & Nathan Nshakira & Nicolas Gerber & Joachim von Braun, 2021. "Impact of community-based health insurance on utilisation of preventive health services in rural Uganda: a propensity score matching approach," International Journal of Health Economics and Management, Springer, vol. 21(2), pages 203-227, June.
    17. Popovici, Ioana & Maclean, J. Catherine & French, Michael, 2017. "The Effects of Health Insurance Parity Laws for Substance Use Disorder Treatment on Traffic Fatalities: Evidence of Unintended Benefits," IZA Discussion Papers 10746, Institute of Labor Economics (IZA).
    18. Thanh Lu, 2021. "Marijuana legalization and household spending on food and alcohol," Health Economics, John Wiley & Sons, Ltd., vol. 30(7), pages 1684-1696, July.
    19. Eiji Yamada, 2020. "Three chapters on spatial and urban economics [Trois chapitres sur l’économie spatiale et urbaine]," SciencePo Working papers Main tel-03767752, HAL.
    20. 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.

    More about this item

    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:wly:hlthec:v:29:y:2020:i:10:p:1180-1201. 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: Wiley Content Delivery (email available below). General contact details of provider: http://www3.interscience.wiley.com/cgi-bin/jhome/5749 .

    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.