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Can value-based insurance impose societal costs?

Lane Koenig1, Timothy M Dall2, David Ruiz3

  • 1KNG Health Consulting, LLC,Rockville, MD.

Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research
|September 20, 2014
PubMed
Summary

Value-based insurance design (VBID) can improve health outcomes. Higher co-pays for total knee arthroplasty (TKA) may offset costs, but delays in care reduce societal savings.

Keywords:
cost sharingsocietal benefitstotal knee replacementvalue-based insurance design

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Area of Science:

  • Health economics
  • Health services research
  • Policy analysis

Background:

  • Value-based insurance design (VBID) is a policy option to reduce healthcare costs and improve outcomes.
  • Oregon implemented a policy requiring higher cost-sharing for procedures like total knee arthroplasty (TKA) for public employees.
  • Most VBID applications have not utilized increased cost-sharing to discourage specific services.

Purpose of the Study:

  • To estimate the societal impact of increased co-payments for TKA.
  • To use Oregon's policy as a case study.
  • To build on existing research on knee osteoarthritis and surgical treatment effects on employment and disability.

Main Methods:

  • A Markov model was employed to estimate societal impact.
  • The model assessed quality of life, direct medical costs, and indirect costs.
  • The study focused on the Oregon public employee case study.

Main Results:

  • Total knee arthroplasty (TKA) can yield societal benefits that exceed direct medical costs for a working population.
  • Delayed surgical care due to higher co-payments or other factors diminishes the societal savings generated by TKA.
  • The study highlights the economic implications of treatment delays.

Conclusions:

  • Payers implementing value-based cost-sharing should consider broader societal consequences beyond direct medical expenditures.
  • The findings suggest that TKA can be cost-effective from a societal perspective.
  • Policy interventions should account for potential delays in accessing necessary surgical procedures.