Reference Pricing, Consumer Cost-Sharing, and Insurer Spending for Advanced Imaging Tests

Area of Science:

• Health Economics
• Health Services Research
• Medical Imaging

Background:

• Healthcare costs for advanced imaging (CT and MRI) vary significantly.
• Reference pricing is an insurance model that limits coverage to a set amount, making patients responsible for costs exceeding this limit.
• This can lead to disparities in insurer spending and patient out-of-pocket expenses.

Purpose of the Study:

• To evaluate the impact of reference pricing on patient choices for imaging facilities.
• To measure changes in test prices, patient out-of-pocket costs, and insurer spending for CT and MRI procedures.
• To assess the association between reference pricing implementation and healthcare expenditure.

Main Methods:

• A difference-in-differences multivariable analysis was employed using insurance claims data.
• The study included 4,751 employees (treatment group) and 23,428 comparison enrollees from 2010-2013.
• Key measures included patient facility choice, price per test, patient cost-sharing, and employer spending.

Main Results:

• Reference pricing was associated with a 12.5% reduction in CT scan prices and a 10.5% reduction in MRI prices by the second year.
• Patient out-of-pocket cost-sharing decreased by 13.8% ($71,508).
• Employees received 45.5% of the total savings generated by reference pricing.

Conclusions:

• Implementing reference pricing effectively reduced healthcare costs for advanced imaging.
• Both patients (employees) and payers (employers) experienced financial benefits from this insurance design.
• Reference pricing demonstrated a significant association with decreased spending in advanced imaging services.