Consequences of cost-sharing for children's health

Area of Science:

• Health economics
• Pediatric health services research
• Medical cost-sharing

Background:

• Understanding the impact of healthcare cost-sharing on pediatric care utilization is crucial.
• Previous research has not fully elucidated the health consequences of reduced ambulatory care use due to family financial responsibility.

Purpose of the Study:

• To investigate whether children whose families bear a percentage of healthcare costs reduce their ambulatory care use.
• To determine if such reductions in care affect children's health outcomes.

Main Methods:

• A randomized controlled trial involving 1,844 children aged 0-13 years over 3 or 5 years.
• Assignment to 14 insurance plans with varying cost-sharing percentages, including a free care option.
• Measurement of ambulatory care use, parental health perceptions, and physiologic health measures.

Main Results:

• Children in families with cost-sharing reduced ambulatory care use by up to one-third.
• No significant differences in parental-perceived health or physiologic measures were found for the typical child.
• Statistically significant health differences were not observed in children at risk of disease, though wider confidence intervals suggest potential undetected differences.

Conclusions:

• Implementing cost-sharing in children's health insurance plans leads to reduced ambulatory care utilization.
• This reduction in care use does not appear to negatively impact the overall health of most children.
• While significant adverse health effects were not detected, the possibility of undetected clinically meaningful differences in certain subgroups warrants further investigation.