Cost sharing and its effects on hospital utilization. The Blue Cross and Blue Shield of North Carolina experience

Area of Science:

• Health Services Research
• Health Economics
• Healthcare Management

Background:

• Traditional health insurance often lacks patient cost-sharing.
• Employer-sponsored health plans are evolving towards models with deductibles and copayments.
• Previous research indicates a correlation between cost-sharing and healthcare utilization.

Purpose of the Study:

• To analyze the shift from traditional health benefits to cost-sharing models.
• To evaluate the impact of these benefit changes on employer financial burden.
• To assess the effect on inpatient utilization rates among employer groups.

Main Methods:

• Study population: Employer groups covered by Blue Cross and Blue Shield of North Carolina.
• Comparison: Groups adopting cost-sharing benefits versus control groups.
• Data analysis: Tracking hospitalization rates and inpatient utilization (days/1000).

Main Results:

• Groups with cost-sharing benefits experienced a decline in inpatient utilization exceeding controls.
• The financial burden on employers was partially shifted.
• Despite declines, utilization days/1000 remained higher than controls post-benefit change.
• No further utilization decline was observed in areas with historically low utilization.

Conclusions:

• Cost-sharing health benefits can reduce inpatient utilization and shift financial responsibility.
• The effectiveness of utilization reduction may vary by region and baseline utilization levels.
• Further research is needed to understand long-term impacts and regional variations in healthcare cost-sharing benefit adoption.