title: Cost-sharing: a blunt instrument.
abstract: Cost-sharing is a health care cost-containment technique in which health care services are partially paid for by patients out of pocket. Cost-sharing can reduce non-cost-effective care, but it can also undermine the financial protection and access values of health insurance. We review the empirical evidence published since the mid-1980s about cost-sharing's effect on utilization, expenditures, health, and adverse consequences, including how the effects vary by form of care, by health status, and by sociodemographic characteristics. Some cost-sharing, such as emergency department copayments, reduces utilization without any harmful effects, whereas other cost-sharing reduces valuable care such as maintenance drug use among the chronically ill. Cost-sharing should be used judiciously, with attention taken not to reduce highly cost-effective care.
authors.affiliation: School of Public Affairs, Baruch College, City University of New York, New York, NY, 10010, USA. Dahlia.Remler@baruch.cuny.edu
authors.forename: Dahlia K
authors.initials: DK
authors.lastname: Remler
authors.forename: Jessica
authors.initials: J
authors.lastname: Greene
mesh_terms: D003363:Cost Control; D017047:Cost Sharing; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics; D006304:Health Status; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D010594:Pharmacies; D011314:Preventive Health Services / Q000191:economics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014481:United States