Effects of cost-sharing on users of a state's health service program

This study analyzed some of the effects of the introduction of cost-sharing on users of the state's health service program. The study population had previously received services at no charge and consisted of people with provider-determined medical need, and included, but was not limited to people in financial need. The study sample was selected from 3 years of program service records (1977-1980). Sampling was random and stratified by key variables. Time-series analysis as well as pre/post-policy comparisons were employed. Analysis of changes in the distributions of service user characteristics and in services provided indicated that use of services was not affected adversely and that lower-income, medically needy people were not deterred from using services following the introduction of cost-sharing. Limitations to the study are reviewed, and implications of using cost-sharing in programs such as Medicaid are considered.