Reference Pricing, Consumer Cost-Sharing, and Insurer Spending for Advanced Imaging Tests
Bibliographic Data
| ID | 9100559 |
|---|---|
| Authors | James C Robinson (0000-0003-4129-4458, Berkeley Public Health Division), Christopher Whaley (0000-0002-9405-1989, Berkeley Public Health Division), Timothy T Brown (0000-0002-5334-0768, Berkeley Public Health Division) |
| Year | 2016 |
| Volume | 54 |
| Issue | 12 |
| Pages | 1050-1055 |
| Publication date | 2016-12-01 |
| Open Access | No |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/mlr.0000000000000605 |
| PMID | 27479594 |
| OpenAlex | W2506974137 |
| Language | EN |
| Citations received | 3 |
| References cited | 13 |
BACKGROUND: Fees charged for similar imaging tests often vary dramatically within the same market, leading to wide variation in insurer spending and consumer cost-sharing. Reference pricing is an insurance design that offers good coverage to patients up to a defined contribution limit but requires the patients who select high-priced facilities to pay the remainder out of pocket. OBJECTIVES: To measure the association between implementation of reference pricing and patient choice of facility, test prices, out-of-pocket spending, and insurer spending for advanced imaging (CT and MRI) procedures. RESEARCH DESIGN: Difference-in-differences multivariable analysis of insurance claims data. Study included 4751 employees of a national grocery chain (treatment group) and 23,428 enrollees in the nation's largest private insurance plan (comparison group) that used CT or MRI tests between 2010 and 2013. MEASURES: Patient choice of facility, price paid per test, patient out-of-pocket cost-sharing, and employer spending. RESULTS: Compared with trends in prices paid by insurance enrollees not subject to reference pricing, and after adjusting for characteristics of tests and patients, implementation of reference pricing was associated with a 12.5% (95% CI, -25.0%, 2.1%) reduction in average price paid per test by the end of the second full year of the program for CT scans and a 10.5% (95% CI, -16.9%, 3.6%) for MRIs. Out-of-pocket cost-sharing by patients declined by $71,508 (13.8%). The savings accruing to employees amounted to 45.5% of total savings from reference pricing, with the remainder accruing to the employer. CONCLUSIONS: Implementation of reference pricing led to reductions in payments by both employer and employees
Actuarial science · Business · Cost sharing · Price discrimination · Test (biology) · Economic and Financial Impacts of Cancer · Health Systems, Economic Evaluations, Quality of Life · Healthcare Policy and Management · Marketing · Medicine
| Citations per year | 0.5 |
|---|---|
| Citation span | 2020 - 2022 (3) |
| Highly cited | No |