IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0187096.html
   My bibliography  Save this article

The effects of patient cost sharing on inpatient utilization, cost, and outcome

Author

Listed:
  • Yuan Xu
  • Ning Li
  • Mingshan Lu
  • Elijah Dixon
  • Robert P Myers
  • Rachel J Jelley
  • Hude Quan

Abstract

Background: Health insurance and provider payment reforms all over the world beg a key empirical question: what are the potential impacts of patient cost-sharing on health care utilization, cost and outcomes? The unique health insurance system and rich electronic medical record (EMR) data in China provides us a unique opportunity to study this topic. Methods: Four years (2010 to 2014) of EMR data from one medical center in China were utilized, including 10,858 adult patients with liver diseases. We measured patient cost-sharing using actual reimbursement ratio (RR) which is allowed us to better capture financial incentive than using type of health insurance. A rigorous risk adjustment method was employed with both comorbidities and disease severity measures acting as risk adjustors. Associations between RR and health use, costs and outcome were analyzed by multivariate analyses. Results: After risk adjustment, patients with more generous health insurance coverage (higher RR) were found to have longer hospital stay, higher total cost, higher medication cost, and higher ratio of medication to total cost, as well as higher number and likelihood that specific procedures were performed. Conclusion: Our study implied that patient cost-sharing affects health care services use and cost. This reflects how patients and physicians respond to financial incentives in the current healthcare system in China, and the responses could be a joint effect of both demand and supply side moral hazard. In order to contain cost and improve efficiency in the system, reforming provide payment and insurance scheme is urgently needed.

Suggested Citation

  • Yuan Xu & Ning Li & Mingshan Lu & Elijah Dixon & Robert P Myers & Rachel J Jelley & Hude Quan, 2017. "The effects of patient cost sharing on inpatient utilization, cost, and outcome," PLOS ONE, Public Library of Science, vol. 12(10), pages 1-16, October.
    • Handle: RePEc:plo:pone00:0187096
    DOI: 10.1371/journal.pone.0187096
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0187096
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0187096&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0187096?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Timothy Powell‐Jackson & Winnie Chi‐Man Yip & Wei Han, 2015. "Realigning Demand and Supply Side Incentives to Improve Primary Health Care Seeking in Rural China," Health Economics, John Wiley & Sons, Ltd., vol. 24(6), pages 755-772, June.
    2. Rainer Winkelmann, 2004. "Co‐payments for prescription drugs and the demand for doctor visits – Evidence from a natural experiment," Health Economics, John Wiley & Sons, Ltd., vol. 13(11), pages 1081-1089, November.
    3. Dahlia K. Remler & Adam J. Atherly, 2003. "Health status and heterogeneity of cost‐sharing responsiveness: how do sick people respond to cost‐sharing?," Health Economics, John Wiley & Sons, Ltd., vol. 12(4), pages 269-280, April.
    4. Devlin, Rose Anne & Sarma, Sisira, 2008. "Do physician remuneration schemes matter? The case of Canadian family physicians," Journal of Health Economics, Elsevier, vol. 27(5), pages 1168-1181, September.
    5. Carine Van De Voorde & Eddy Van Doorslaer & Erik Schokkaert, 2001. "Effects of cost sharing on physician utilization under favourable conditions for supplier‐induced demand," Health Economics, John Wiley & Sons, Ltd., vol. 10(5), pages 457-471, July.
    6. Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-277, June.
    7. Suwei Yuan & Yan Liu & Na Li & Yunting Zhang & Zhe Zhang & Jingjing Tao & Lizheng Shi & Hude Quan & Mingshan Lu & Jin Ma, 2014. "Impacts of Health Insurance Benefit Design on Percutaneous Coronary Intervention Use and Inpatient Costs among Patients with Acute Myocardial Infarction in Shanghai, China," PharmacoEconomics, Springer, vol. 32(3), pages 265-275, March.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Schmitz, Hendrik, 2013. "Practice budgets and the patient mix of physicians – The effect of a remuneration system reform on health care utilisation," Journal of Health Economics, Elsevier, vol. 32(6), pages 1240-1249.
    2. Ha Trong Nguyen & Luke B Connelly, 2017. "Cost-sharing in health insurance and its impact in a developing country: evidence from a quasi-natural experiment," Bankwest Curtin Economics Centre Working Paper series WP1702, Bankwest Curtin Economics Centre (BCEC), Curtin Business School.
    3. Mas, Nuria & Cirera, Laia & Viñolas, Guillem, 2011. "Los sistemas de copago en Europa, Estados Unidos y Canadá: Implicaciones para el caso español," IESE Research Papers D/939, IESE Business School.
    4. Perronnin, Marc, 2013. "Effet de l'assurance complémentaire santé sur les consommations médicales, entre risque moral et amélioration de l'accès aux soins," Economics Thesis from University Paris Dauphine, Paris Dauphine University, number 123456789/13659 edited by Wittwer, Jérôme.
    5. Astrid Kiil & Kurt Houlberg, 2014. "How does copayment for health care services affect demand, health and redistribution? A systematic review of the empirical evidence from 1990 to 2011," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(8), pages 813-828, November.
    6. Pierre-Thomas Léger & Erin C. Strumpf, 2010. "Système de paiement des médecins : bref de politique," CIRANO Project Reports 2010rp-12, CIRANO.
    7. Trottmann, Maria & Zweifel, Peter & Beck, Konstantin, 2012. "Supply-side and demand-side cost sharing in deregulated social health insurance: Which is more effective?," Journal of Health Economics, Elsevier, vol. 31(1), pages 231-242.
    8. Huck, Steffen & Lünser, Gabriele & Spitzer, Florian & Tyran, Jean-Robert, 2016. "Medical insurance and free choice of physician shape patient overtreatment: A laboratory experiment," Journal of Economic Behavior & Organization, Elsevier, vol. 131(PB), pages 78-105.
    9. Berger, Michael & Six, Eva & Czypionka, Thomas, 2024. "Policy implications of heterogeneous demand reactions to changes in cost-sharing: Patient-level evidence from Austria," Social Science & Medicine, Elsevier, vol. 340(C).
    10. Landsem, Mari Magnussen & Magnussen, Jon, 2018. "The effect of copayments on the utilization of the GP service in Norway," Social Science & Medicine, Elsevier, vol. 205(C), pages 99-106.
    11. Erik Schokkaert & Carine Van de Voorde, 2005. "Health care reform in Belgium," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 25-39, September.
    12. Berger, Michael & Six, Eva & Czypionka, Thomas, 2024. "Policy implications of heterogeneous demand reactions to changes in cost-sharing: patient-level evidence from Austria," LSE Research Online Documents on Economics 121162, London School of Economics and Political Science, LSE Library.
    13. Hudson, Eibhlin & Nolan, Anne, 2015. "Public healthcare eligibility and the utilisation of GP services by older people in Ireland," The Journal of the Economics of Ageing, Elsevier, vol. 6(C), pages 24-43.
    14. Vanessa Cirulli & Giuliano Resce & Marco Ventura, 2024. "Co-payment exemption and healthcare consumption: quasi-experimental evidence from Italy," Empirical Economics, Springer, vol. 67(1), pages 355-380, July.
    15. Nicolas Ziebarth, 2014. "Assessing the effectiveness of health care cost containment measures: evidence from the market for rehabilitation care," International Journal of Health Economics and Management, Springer, vol. 14(1), pages 41-67, March.
    16. Hennig-Schmidt, Heike & Selten, Reinhard & Wiesen, Daniel, 2011. "How payment systems affect physicians' provision behaviour--An experimental investigation," Journal of Health Economics, Elsevier, vol. 30(4), pages 637-646, July.
    17. Christel E. van Dijk & Bernard van den Berg & Robert A. Verheij & Peter Spreeuwenberg & Peter P. Groenewegen & Dinny H. de Bakker, 2013. "Moral Hazard And Supplier‐Induced Demand: Empirical Evidence In General Practice," Health Economics, John Wiley & Sons, Ltd., vol. 22(3), pages 340-352, March.
    18. Cockx, Bart & Brasseur, Carine, 2003. "The demand for physician services: Evidence from a natural experiment," Journal of Health Economics, Elsevier, vol. 22(6), pages 881-913, November.
    19. Diana De Graeve & Tom Van Ourti, 2003. "The Distributional Impact of Health Financing in Europe: A Review," The World Economy, Wiley Blackwell, vol. 26(10), pages 1459-1479, November.
    20. Jan Zápal, 2010. "Doctor-Visit Co-Payment Exemption for Children: First Look at the Data," Czech Journal of Economics and Finance (Finance a uver), Charles University Prague, Faculty of Social Sciences, vol. 60(1), pages 58-72, February.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0187096. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.