Effect of shifting costs to patients on specialty evaluation for sleep disorders.
OBJECTIVE
To determine whether the introduction of out-of-pocket expenses to medical center employees would lead to decreased use of sleep disorder services.


METHODS
We retrospectively analyzed and compared the clinical and medical accounting data from visits by Mayo Clinic employees to the Sleep Disorders Center from January 1 to March 31, 2003, with that of January 1 to March 31, 2004, le, before and after a January 2004 increase in co-payments for evaluation and testing.


RESULTS
The total number of new patients evaluated in the first quarters of 2003 and 2004 was similar (113 vs 119; P = .37). Snoring, restless legs symptoms, hypertension, atrial fibrillation, and prior overnight oximetry testing were more prevalent in 2004 than in 2003 (P = .05, P = .01, P < .001, P = .003, P = .02, respectively). In contrast, insomnia and parasomnia complaints were less common in 2004 (P < .001). The mean apnea-hypopnea index, minimum oxygen saturation, and percentage of time with oxygen saturation less than 90% were all more severe in 2004 (P = .01, P = .001, P < .001, respectively). Sleep-related breathing disorders were more commonly diagnosed in 2004 (83.2% vs 67.2%; P = .02), whereas the diagnoses of nonbreathing disorders declined.


CONCLUSIONS
The insurance policy changes that resulted in larger employee co-payments shifted the spectrum of diagnoses seen at the Sleep Disorders Center toward more symptomatic patients, with more associated comorbidities, and patients who had more severe sleep-related breathing disorders. Total utilization did not decrease.
Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Joseph G
JG
Parambil
Eric J
EJ
Olson
John W
JW
Shepard
Cameron D
CD
Harris
Brian J
BJ
Schniepp
Elaine E G
EE
Schembari
Timothy I
TI
Morgenthaler
D000046:Academic Medical Centers; D000328:Adult; D003361:Cost Allocation; D005251:Fees, Medical; D005260:Female; D006264:Health Benefit Plans, Employee / Q000458:organization & administration*; D005102:Health Expenditures; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012893:Sleep Wake Disorders / Q000175:diagnosis* / Q000191:economics / Q000523:psychology