Trends in patient cost sharing for clinical services used as quality indicators

Patient copayments for all medical services have increased dramatically. There are few data available regarding how copayments have changed for services commonly considered to be quality indicators.

Describe the relative change in copayments for services used as quality indicators and interventions subject to programs to control utilization.

A large claims database was used to assess copayment changes from 2001 to 2006 for selected drug and non-drug services in patient cohorts with specific chronic diseases.

Approximately 5 million commercially-insured individuals enrolled in a variety of fee-for-service and capitated health plans.

Copayment trends were calculated as the change in the average amount paid per unit service from 2001 to 2006.

Out-of-pocket payments for services targeted by quality improvement initiatives increased substantially [>50%] and in a similar magnitude to interventions subject to programs to control their use. For prescription drugs, the trend was driven more by copayment increases for branded medications [$10 per prescription] than for generic drugs [$2 per prescription]. Copayments for non-drug preventive services rose modestly.

Benefit designers should consider reversing the trend of copayment increases for services considered to be indicators of high quality care.