OBJECTIVES: To determine the impact of introducing copayments on medical care use and expenditures for low-income, adult Medicaid beneficiaries. DATA SOURCES/STUDY SETTING: The Oregon Health Plan (OHP) implemented copayments and other benefit changes for some adult beneficiaries in February 2003. STUDY DESIGN: Copayment effects were measured as the "difference-in-difference" in average monthly service use and expenditures among cohorts of OHP Standard (intervention) and Plus (comparison) beneficiaries. DATA COLLECTION/EXTRACTION METHODS: There were 10,176 OHP Standard and 10,319 Plus propensity score-matched subjects enrolled during November 2001-October 2002 and May 2003-April 2004 that were selected and assigned to 59 primary care-based service areas with aggregate outcomes calculated in six month intervals yielding 472 observations. RESULTS: Total expenditures per person remained unchanged (+2.2 percent, p=.47) despite reductions in use (-2.7 percent, p<.001). Use and expenditures per person decreased for pharmacy (-2.2 percent, p<.001; -10.5 percent, p<.001) but increased for inpatient (+27.3 percent, p<.001; +20.1 percent, p=.03) and hospital outpatient services (+13.5 percent, p<.001; +19.7 percent, p<.001). Ambulatory professional (-7.7 percent, p<.001) and emergency department (-7.9 percent, p=.03) use decreased, yet expenditures remained unchanged (-1.5 percent, p=.75; -2.0 percent, p=.68, respectively) as expenditures per service user rose (+6.6 percent, p=.13; +7.9 percent, p=.03, respectively). CONCLUSIONS: In the Oregon Medicaid program applying copayments shifted treatment patterns but did not provide expected savings. Policy makers should use caution in applying copayments to low-income Medicaid beneficiaries.
OBJECTIVES: To determine the impact of introducing copayments on medical care use and expenditures for low-income, adult Medicaid beneficiaries. DATA SOURCES/STUDY SETTING: The Oregon Health Plan (OHP) implemented copayments and other benefit changes for some adult beneficiaries in February 2003. STUDY DESIGN: Copayment effects were measured as the "difference-in-difference" in average monthly service use and expenditures among cohorts of OHP Standard (intervention) and Plus (comparison) beneficiaries. DATA COLLECTION/EXTRACTION METHODS: There were 10,176 OHP Standard and 10,319 Plus propensity score-matched subjects enrolled during November 2001-October 2002 and May 2003-April 2004 that were selected and assigned to 59 primary care-based service areas with aggregate outcomes calculated in six month intervals yielding 472 observations. RESULTS: Total expenditures per person remained unchanged (+2.2 percent, p=.47) despite reductions in use (-2.7 percent, p<.001). Use and expenditures per person decreased for pharmacy (-2.2 percent, p<.001; -10.5 percent, p<.001) but increased for inpatient (+27.3 percent, p<.001; +20.1 percent, p=.03) and hospital outpatient services (+13.5 percent, p<.001; +19.7 percent, p<.001). Ambulatory professional (-7.7 percent, p<.001) and emergency department (-7.9 percent, p=.03) use decreased, yet expenditures remained unchanged (-1.5 percent, p=.75; -2.0 percent, p=.68, respectively) as expenditures per service user rose (+6.6 percent, p=.13; +7.9 percent, p=.03, respectively). CONCLUSIONS: In the Oregon Medicaid program applying copayments shifted treatment patterns but did not provide expected savings. Policy makers should use caution in applying copayments to low-income Medicaid beneficiaries.
Authors: John Hsu; Mary Price; Richard Brand; G Thomas Ray; Bruce Fireman; Joseph P Newhouse; Joseph V Selby Journal: Health Serv Res Date: 2006-10 Impact factor: 3.402
Authors: K N Lohr; R H Brook; C J Kamberg; G A Goldberg; A Leibowitz; J Keesey; D Reboussin; J P Newhouse Journal: Med Care Date: 1986-09 Impact factor: 2.983
Authors: R Tamblyn; R Laprise; J A Hanley; M Abrahamowicz; S Scott; N Mayo; J Hurley; R Grad; E Latimer; R Perreault; P McLeod; A Huang; P Larochelle; L Mallet Journal: JAMA Date: 2001 Jan 24-31 Impact factor: 56.272
Authors: J V Selby; B H Fireman; R J Lundstrom; B E Swain; A F Truman; C C Wong; E S Froelicher; H V Barron; M A Hlatky Journal: N Engl J Med Date: 1996-12-19 Impact factor: 91.245
Authors: K John McConnell; Stephanie Renfro; Richard C Lindrooth; Deborah J Cohen; Neal T Wallace; Michael E Chernew Journal: Health Aff (Millwood) Date: 2017-03-01 Impact factor: 6.301
Authors: Neal T Wallace; Matthew J Carlson; David M Mosen; John J Snyder; Bill J Wright Journal: Am J Public Health Date: 2011-06-16 Impact factor: 9.308
Authors: Amy Finkelstein; Sarah Taubman; Bill Wright; Mira Bernstein; Jonathan Gruber; Joseph P Newhouse; Heidi Allen; Katherine Baicker Journal: Q J Econ Date: 2012-05-03
Authors: H Angier; J P O'Malley; M Marino; K J McConnell; E Cottrell; R L Jacob; S Likumahuwa-Ackman; J Heintzman; N Huguet; S R Bailey; J E DeVoe Journal: Contemp Clin Trials Date: 2016-11-09 Impact factor: 2.226