Is higher cost sharing an effective strategy for reducing health care spending? A new study published today in Health Affairs illustrates one of problems with the theory that increasing co-pays and deductibles will lead consumers to make more cost-effective choices about their health care. It suggests that decreasing co-pays may be the better policy choice for some types of health care treatments, in order to increase adherence to the appropriate treatment regime. The study considers an approach known as value-based insurance design (VBID), which is a strategy for improving health care quality while controlling health spending. According to the Health Affairs article, “VBID programs are intended to promote the use of services or treatments that provide high benefits relative to cost and, alternatively, to discourage the use of services whose benefits do not justify their cost.”

The new Commonwealth Fund–supported study examined the use of a VBID program at the U.S. technology company Pitney Bowes to make medications of proven value less expensive for their employees. The program eliminated copayments for cholesterol-lowering statins and reduced them for clopidogrel, a blood clot inhibitor.

The study found that adherence to cholesterol-lowering statin drugs, which had been on the decline, immediately stabilized after Pitney Bowes eliminated copays for the drugs for all employees and beneficiaries who had diabetes or vascular disease.  Adherence to statins was 2.8 percent higher in the Pitney Bowes group than in a control group of patients. Similarly, the reduction of copays for clopidogrel led to a 4 percent higher adherence rate than the control group.

The authors conclude that value-based insurance programs can serve as “an alternative to the current trend of rising cost-sharing faced by the majority of commercially insured patients.” The study’s authors acknowledge that the improvements in adherence were “relatively modest,” but they believe those changes could be enhanced through additional policies that address “suboptimal” use of health care services – by, for example, granting copayment waivers only to enrollees who participate in a disease management program.

Jon Peacock