Related Experiment Video
Updated: Mar 21, 2026
Making MR Imaging Child's Play - Pediatric Neuroimaging Protocol, Guidelines and Procedure
Published on: July 30, 2009
Elimination of the Out-of-Pocket Charge for Children's Primary Care Visits: An Application of Value-Based Insurance
Martín-J Sepúlveda1, M Christopher Roebuck2, Paul Fronstin3
1IBM Corporation, Yorktown Heights, NY.
Insights
Eliminating out-of-pocket costs for primary care increased physician visits and preventive services for children. This value-based insurance design showed positive impacts on health services without significantly increasing total healthcare costs.
Area of Science:
- Health Services Research
- Health Economics
- Pediatric Health
Background:
- Value-based insurance design (VBID) aims to align out-of-pocket costs with healthcare value.
- Primary care access is crucial for child development and preventive care.
Purpose of the Study:
- To evaluate the impact of zero out-of-pocket costs for primary care physician visits on children's healthcare utilization and costs.
Main Methods:
- Retrospective analysis of health claims data for 25,950 children.
- Propensity score matching to create a control group.
- Difference-in-differences models to assess changes in health services and costs over 24 months.
Main Results:
- Zero out-of-pocket costs significantly increased primary care visits (+32%) and preventive services (well-child visits, vaccinations).
- Emergency department visits (-5%) and specialist visits (-12%) decreased.
- Employer primary care costs rose ($29/child), but total healthcare costs per child remained stable.
Conclusions:
- Value-based insurance design, by removing cost barriers for primary care, positively impacts children's health services.
- Broader deployment of this VBID model is warranted, with consideration for exempting primary care from cost-sharing.
Objective:
To evaluate the impact of a value-based insurance design for primary care among children.
Study Design:
A retrospective analysis of health care claims data on 25 950 children (<18 years of age) was conducted. Individuals were enrolled in a large employer's health plans when zero out-of-pocket cost for primary care physician visits was implemented. A rigorous propensity score matching process was used to generate a control group of equal size from a database of other employer-sponsored insurees. Multivariate difference-in-differences models estimated the effect of zero out-of-pocket cost on 21 health services and cost outcomes 24 months after intervention.
Results:
Zero out-of-pocket cost for primary care was associated with significant increases (P < .01) in primary care physician visits (+32 per 100 children), as well as decreases in emergency department (-5 per 100 children) and specialist physician visits (-12 per 100 children). The number of prescription drug fills also declined (-20 per 100 children), yet medication adherence for 3 chronic conditions was unaffected. The receipt of well child visits and 4 recommended vaccinations were all significantly (P < .05) greater under the new plan design feature. Employer costs for primary care increased significantly (P < .01) in association with greater utilization ($29 per child), but specialist visit costs declined (-$12 per child) and total health care costs per child did not exhibit a statistically significant increase.
Conclusion:
This novel application of value-based insurance design warrants broader deployment and assessment of its longer term outcomes. As with recommended preventive services, policymakers should consider exempting primary care from health insurance cost-sharing.
Related Concept Videos
01:30Preventive Healthcare Services
01:30Primary Healthcare Services
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
01:11Secondary Healthcare System
01:22Standards of Care I
01:30Health Information Technology and Healthcare Information System
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include: