X hits on this document

457 views

0 shares

0 downloads

0 comments

45 / 98

further reduced per capita expenditures for care.14 Moreover, at lower levels of cost-sharing, the

elasticity of demand for care was lower. Among people with a coinsurance rate less than 25

percent, the estimated out-of-pocket price elasticity was –0.17, compared with –0.22 among

people with a coinsurance rate between 25 and 95 percent. In contrast, differences in out-of-

pocket maximums did not significantly affect demand.

More recent studies on the responsiveness of health expenditures to cost sharing have relied

on insurance claims data to estimate demand, in contrast to the random-assignment experimental

method of the HIE. For example, Eichner (1998) used 1990-1992 insurance claims data from a

single large employer to estimate consumers’ response to the effective reduction in the price of

care that occurs as plan participants reach their deductible. Eichner estimated a price elasticity of

expenditures between -0.62 and –0.75, larger than most other estimates of this type.15

2.

Subpopulation Differences

Analyses of the HIE found that lower-income consumers were more responsive to cost

sharing than those with higher incomes. Participants with income in the lowest third of the

sample and enrolled in the free plan were 34 percent more likely to use health services of any

kind than low-income participants in plans with cost-sharing. Among those with incomes in the

top third, this difference was only 22 percent (Manning et al. 1987).

More recent analyses of income-related differences in utilization have relied on observation

of

demand

in

public

programs,

which

obtain

information

about

household

income.

For

population subgroups eligible for Medicaid and SCHIP—largely women and children—the

14 A $3,200 family deductible (in 2004 dollars) with no additional cost sharing would reduce average medical expenditures by 31 percent, relative to a plan with free care (Morrissey 2005).

15 As another example, using insurance data from the early 1990sto look at the effects of alternative deductibles among middle- to upper-income individuals in the Netherlands, Van Vliet (2004) estimated an overall deductible elasticity of –0.14. In this study, once the deductible was satisfied there was little or no out-of-pocket payment for services.

35

Document info
Document views457
Page views458
Page last viewedThu Dec 08 02:05:14 UTC 2016
Pages98
Paragraphs2978
Words29067

Comments