title: Cost-sharing for low-income workers: health insurance in the on-your-ownership society.
abstract: Effects of increased cost-sharing in Washington State's Basic Health Plan (BHP) were assessed among adult BHP beneficiaries (N=14,515) and age-sex-residence matched controls enrolled in Group Health Cooperative. The BHP enrollees had higher disenrollment than controls before and after cost-sharing increases, but disenrollment did not change with increased cost-sharing. Basic Health Plan enrollees' out-of-pocket-costs increased 100% in two years, compared with 42% for controls. Out-of-pocket costs for BHP enrollees with diabetes increased 61% (from $675 to $1,086), while the 90th percentile increased 74%, from $1,358 to $2,365. Basic Health Plan enrollees had somewhat fewer visits than controls after cost-sharing increases, but total costs, timeliness of glucose monitoring, and glycemic control were unaffected. Cost-sharing changes increased out-of-pocket costs for BHP enrollees without affecting total costs, disenrollment, or diabetes quality of care indicators. The predominant effect of increased cost-sharing was to increase costs for low-income workers, particularly those with chronic disease.
authors.affiliation: Group Health Center for Health Studies, 1730 Minor Avenue, Seattle, WA 98101, USA. vonkorff.m@ghc.org
authors.forename: Michael
authors.initials: M
authors.lastname: Von Korff
authors.forename: Malia
authors.initials: M
authors.lastname: Oliver
authors.forename: Paul
authors.initials: P
authors.lastname: Fishman
authors.forename: John
authors.initials: J
authors.lastname: Burbank
mesh_terms: D000328:Adult; D017047:Cost Sharing / Q000191:economics* / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000628:therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D005102:Health Expenditures; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000191:economics* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000458:organization & administration; D013221:State Health Plans / Q000458:organization & administration; D014861:Washington
chemical_list: D006442:Glycated Hemoglobin