Journal
HEALTH ECONOMICS
Volume 21, Issue 8, Pages 902-912Publisher
WILEY
DOI: 10.1002/hec.1759
Keywords
costs; longitudinal; mixed model; random effects; health econometrics; zero-inflated data; specialty care; co-payment; cost sharing
Funding
- Office of Research and Development, Health Services Research and Development Service, Department of Veterans Affairs [IIR 03-200]
- Department of Veterans Affairs [RCS 10-391]
- Novartis
- Takeda Pharmaceuticals
- Surgical Review Corporation
Ask authors/readers for more resources
Objectives Outpatient visit co-payments have increased in recent years. We estimate the patient response to a price change for specialty care, based on a co-payment increase from $15 to $50 per visit for veterans with hypertension. Design, Setting, and Patients A retrospective cohort of veterans required to pay co-payments was compared with veterans exempt from co-payments whose nonequivalence was reduced via propensity score matching. Specialty care expenditures in 20002003 were estimated via a two-part mixed model to account for the correlation of the use and level outcomes over time, and results from this correlated two-part model were compared with an uncorrelated two-part model and a correlated random intercept two-part mixed model. Results A $35 specialty visit co-payment increase had no impact on the likelihood of seeking specialty care but induced lower specialty expenditures over time among users who were required to pay co-payments. The log ratio of price responsiveness (semi-elasticity) for specialty care increased from -0.25 to -0.31 after the co-payment increase. Estimates were similar across the three models. Conclusion A significant increase in specialty visit co-payments reduced specialty expenditures among patients obtaining medications at the Veterans Affairs medical centers. Longitudinal expenditure analysis may be improved using recent advances in two-part model methods. Published 2011. This article is a US Government work and is in the public domain in the USA.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available