"For example, you may need to pay $20 for a visit to your primary care physician (PCP) or $250 for an ER visit. This co-pay is partially designed to offset the expense associated with the consumption of health care services. But it is equally clear that if you are strapped for cash, it makes you think twice before going to the ER rather than your PCP. There is a deterrent effect."
I think this is true in principle and in some cases but I wonder how it plays out in the current environment. Insured cost-shares were a major health policy topic in the '90s. The idea was that insureds need some "skin in the game" so they will make more cost-effective choices.
I wonder how that plays out now for people who can't get an appointment with their PCP for weeks, which is certainly my experience. The typical alternative is an urgent care center, which depending on where you are may or may not be in-network. I suspect most people opt for that rather than an ER, but I haven't looked into it.
There's also the fact that in the high-cost cases the patient isn't in much of a position to make a decision. I know of a case where an ambulance was delayed taking a patient while the EMTs tried to find out which of four or five available hospitals was in-network for the patient, and get the patient, who was having severe chst pain, to choose. This is the reason I wonder how much real effect Transparency Act requirements will have on patient decisions.
So true about getting an apptmt with your PCP! But the "skin in the game" credo is alive and well in healthcare. And patients don't always make "good decisions" . Prescription abandonment is a great example of how benefit design can have a deterrent effect, and since member contribution is almost never tied to any value associated with the good or service, bad decisions get made all the time. But transparency can help in many ways. If you know that the CT scan performed in the free standing image center costs a lot less than the one in the hospital, and you personally share in the savings, why wouldn't you make a value driven choice?
You comment:
"For example, you may need to pay $20 for a visit to your primary care physician (PCP) or $250 for an ER visit. This co-pay is partially designed to offset the expense associated with the consumption of health care services. But it is equally clear that if you are strapped for cash, it makes you think twice before going to the ER rather than your PCP. There is a deterrent effect."
I think this is true in principle and in some cases but I wonder how it plays out in the current environment. Insured cost-shares were a major health policy topic in the '90s. The idea was that insureds need some "skin in the game" so they will make more cost-effective choices.
I wonder how that plays out now for people who can't get an appointment with their PCP for weeks, which is certainly my experience. The typical alternative is an urgent care center, which depending on where you are may or may not be in-network. I suspect most people opt for that rather than an ER, but I haven't looked into it.
There's also the fact that in the high-cost cases the patient isn't in much of a position to make a decision. I know of a case where an ambulance was delayed taking a patient while the EMTs tried to find out which of four or five available hospitals was in-network for the patient, and get the patient, who was having severe chst pain, to choose. This is the reason I wonder how much real effect Transparency Act requirements will have on patient decisions.
Thanks for the post!
So true about getting an apptmt with your PCP! But the "skin in the game" credo is alive and well in healthcare. And patients don't always make "good decisions" . Prescription abandonment is a great example of how benefit design can have a deterrent effect, and since member contribution is almost never tied to any value associated with the good or service, bad decisions get made all the time. But transparency can help in many ways. If you know that the CT scan performed in the free standing image center costs a lot less than the one in the hospital, and you personally share in the savings, why wouldn't you make a value driven choice?
A little complicated to follow, but clear and concise.