Rising out-of-pocket costs in disease management programs.
OBJECTIVE
To document the rise in copayments for patients in disease management programs and to call attention to the inherent conflicts that exist between these 2 approaches to benefit design.


METHODS
Data from 2 large health plans were used to compare cost sharing in disease management programs with cost sharing outside of disease management programs.


RESULTS
The copayments charged to participants in disease management programs usually do not differ substantially from those charged to other beneficiaries.


CONCLUSIONS
Cost sharing and disease management result in conflicting approaches to benefit design. Increasing copayments may lead to underuse of recommended services, thereby decreasing the clinical effectiveness and increasing the overall costs of disease management programs. Policymakers and private purchasers should consider the use of targeted benefit designs when implementing disease management programs or redesigning cost-sharing provisions. Current information systems and health services research are sufficiently advanced to permit these benefit designs.
Chernew
Michael E
ME
University of Michigan, Ann Arbor, MI 48109-2029, USA. ggbz@umich.edu
Rosen
Allison B
AB
Fendrick
A Mark
AM
D017047:Cost Sharing / Q000639:trends*; D019468:Disease Management; D006801:Humans; D008329:Managed Care Programs; D014481:United States