Journal
ANNUAL REVIEW OF PUBLIC HEALTH
Volume 30, Issue -, Pages 293-311Publisher
ANNUAL REVIEWS
DOI: 10.1146/annurev.publhealth.29.020907.090804
Keywords
cost-containment; health insurance; cost-effective care; access; consumer-driven health plans
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Cost-sharing is a health care cost-containment technique in which health care services are partially paid for by patients out of pocket. Cost-sharing can reduce non-cost-effective care, but it can also undermine the financial protection and access values of health insurance. We review the empirical evidence published since die mid-1980s about cost-sharing's effect on utilization, expenditures, health, and adverse consequences, including how the effects vary by form of care, by health status, and by sociodemographic characteristics. Some cost-sharing, such as emergency department copayments, reduces utilization without any harmful effects, whereas other cost-sharing reduces valuable care such as maintenance drug use among the chronically ill. Cost-sharing should be used judiciously, with attention taken not to reduce highly cost-effective care.
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