The Issue
Research suggests when making decisions about health care treatments, people have difficulty distinguishing high value from low value. As a result, across-the-board patient cost-sharing in the form of copayments and deductibles tends to reduce the use of both appropriate and inappropriate care in nearly equal amounts. Tiered cost-sharing systems, like those used by many U.S. payers for prescription drug coverage, offer greater promise to promote use of high-value care, as they require higher copayments for drugs deemed to be of lower value or cost-effectiveness.
What the Study Found
Researchers reviewed efforts in the United States and several other member countries of the Organization for Economic Cooperation and Development (OECD) to encourage patients to use drugs, services, and preferred providers that offer better value than other options. These value-based cost-sharing approaches include:
- removing services that are not cost-effective from the health benefit package;
- increasing the patients’ share of cost-sharing for drugs, interventions, and office visits to providers viewed as providing low value; and
- reducing or removing copayments for services deemed of high value.
The Commonwealth Fund–supported researchers found that although many OECD countries are using value-based approaches to steer patients toward more efficient and less costly care, use of such strategies is limited by a lack of information about the value of many health care interventions. The high cost of comparative effectiveness studies may deter countries from more broadly pursuing value-based policies.
Conclusions
Value-based cost-sharing can be an important tool for encouraging high-value health care. However, the authors caution that this approach requires careful design, implementation, and continuous evaluation.