Benefit plan design and prescription drug utilization among asthmatics: do patient copayments matter?

NBER/Frontiers in Health Policy Research 02/2004; 7:95-127. DOI: 10.2202/1558-9544.1053
Source: PubMed


The ratio of controller-to-reliever medication use has been proposed as a measure of treatment quality for asthma patients. In this study we examine the effects of plan-level mean out-of-pocket asthma medication patient copayments and other features of benefit plan design on the use of controller medications alone, controller and reliever medications (combination therapy), and reliever medications alone. The 1995--2000 MarketScan claims data were used to construct plan-level out-of-pocket copayment and physician/practice prescriber preference variables for asthma medications. Separate multinomial logit models were estimated for patients in fee-for-service (FFS) and non-FFS plans relating benefit plan design features, physician/practice prescribing preferences, patient demographics, patient comorbidities, and county-level income variables to patient-level asthma treatment patterns. We find that the controller-to-reliever ratio rose steadily over 1995--2000, along with out-of-pocket payments for asthma medications, which rose more for controllers than for relievers. After controlling for other variables, however, plan-level mean out-of-pocket copayments were not found to have a statistically significant influence on patient-level asthma treatment patterns. On the other hand, physician/practice prescribing patterns strongly influenced patient-level treatment patterns. There is no strong statistical evidence that higher levels of out-of-pocket copayments for prescription drugs influence asthma treatment patterns. However, physician/practice prescribing preferences influence patient treatment.

Download full-text


Available from: William H Crown, Jun 14, 2014
1 Follower
16 Reads
  • Source
    • "In addition to the HIE, there exists more recent empirical evidence on how cost-sharing affects the demand for health care (Chiappori et al. 1998; Van De Voorde et al. 2001; Cockx and Brasseur 2003; Goldman et al. 2004; Winkelmann 2004; Crown et al. 2004; van Vliet 2004; Landsman et al. 2005; Gerfin and Schellhorn 2006; Gaynor et al. 2007; Goldman et al. 2007; Schreyögg and Grabka 2010; Chandra et al. 2010). Baicker and Goldman (2011) as well as Swartz (2007) provide excellent state-of-the-art overviews of the effects of demand-side cost-sharing on health care utilization, health outcomes, and health spending. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study empirically evaluates the effectiveness of different health care cost containment measures. The measures investigated were introduced in Germany in 1997 to reduce moral hazard and public health expenditures in the market for rehabilitation care. Of the analyzed measures, doubling the daily copayments was clearly the most effective cost containment measure, resulting in a reduction in utilization of about [Formula: see text] . Indirect measures such as allowing employers to cut federally mandated sick pay or paid vacation during inpatient post-acute care stays did not significantly reduce utilization. There is evidence neither for adverse health effects nor for substitution effects in terms of more doctor visits.
    International Journal of Health Care Finance and Economics 12/2013; 14(1). DOI:10.1007/s10754-013-9138-1 · 0.49 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Drug utilisation study methodology is revised in this paper, with particular attention to the suitability of medication prescribed in the primary care area. A distinction is drawn between predictive and regulatory studies. The potential and limitations of information systems are explored. With the computerisation of medical histories in Spain, suitability studies using multilevel regression can now be conducted to assign ¿responsibilities¿ for inefficiencies to the various actors involved: patient, physician and organisational or institutional environment. An empirical study on the suitability of the use of proton pump inhibitors is taken as an example to illustrate the methodology proposed. En este artículo se revisa la metodología de los Estudios de Utilización de Medicamentos (EUM), prestando especial atención a los de adecuación de la prescripción y al ámbito de atención primaria. Se diferencia entre estudios predictivos y normativos. Se exploran las posibilidades y limitaciones de los sistemas de información. La informatización de las historias de salud empieza a permitir en España que los estudios de adecuación, utilizando regresión multinivel, asignen «responsabilidades» de la ineficiencia a los niveles que correspondan, paciente, médico, y entorno organizativo o institucional. Se ilustran esas propuestas metodológicas con un estudio empírico de adecuación de inhibidores de la bomba de protones.
    01/2004; 67(67).
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Research over the past decade has provided information concerning the onset and treatment of allergic diseases, including bronchial asthma, allergic rhinitis and atopic dermatitis. Recent studies also indicated that allergic inflammation is the basic pathophysiology of allergic diseases and is closely associated with their progression and exacerbation. Our understanding of the mechanism of allergic inflammation with regard to therapeutic agents has improved as a result of immunological and molecular biological studies. While much effort has been paid to developing a new anti-allergic drug, allergic disease has yet to be completely conquered. More extensive research will allow the development of new therapeutics to combat allergic diseases. This article provides an overview of recent advances in the development of anti-allergic drugs.
    Allergology International 04/2006; 55(1):35-42. DOI:10.2332/allergolint.55.35 · 2.46 Impact Factor
Show more