Are High Cost‐Sharing Policies for Physician Care Associated With Reduced Care Utilization and Costs Differently by Health Status?

The study examined whether high cost‐sharing policies for physician care are associated with reduced care utilization and costs differently between individuals with and without chronic conditions. Findings from this study contribute to the benefit structure design of health plans that may improve care delivery efficiencies and maintain health outcomes among chronically ill individuals. The study used the 2010–2011 Medical Expenditure Panel Survey data with a retrospective cohort study design. Difference in difference, negative binomial regression, and generalized linear models were employed to analyze the utilization and cost data. In order to account for national survey sampling design, weight and variance were adjusted. The study sample consisted of 4,368 individuals. Multivariate analysis and sensitivity analysis found consistent patterns between utilization and cost models. High cost‐sharing policies for physician care were not associated with different levels of reductions in care utilization and costs between chronically ill people and healthy people (all at p  > 0.05). However, the stratification analysis indicated that chronically ill people reduced physician care use and costs to the similarly significant extent as healthy people in response to high cost‐sharing policies. Relative to non‐chronically ill individuals, chronically ill individuals may decrease their care utilization and expenditures to a similarly significant extent in response to increased physician care cost sharing. This may be due to patients' inability to discern care cost‐effectiveness, a short observation window, and chronic condition characteristics. It is possible that, in the long run, these sick people would demonstrate substantial demands for downstream medical care, such as inpatient care, and there could ultimately be a total cost increase for them and their families at the micro level. Health plans need to be cautious of policies for chronically ill private enrollees, such as considering a low cost‐sharing policy for physician care or primary care. Individuals with chronic conditions may consider insurance plans with low levels of cost sharing in physician care, especially when more public information about health plan features and designs is available to facilitate their decision‐making process. Future studies should examine this research question with a longer observation period and with more measures, such as physician behaviors.