title: Trends in patient cost sharing for clinical services used as quality indicators.
abstract: BACKGROUND
  Patient copayments for all medical services have increased dramatically. There are few data available regarding how copayments have changed for services commonly considered to be quality indicators.
  
  
  OBJECTIVE
  Describe the relative change in copayments for services used as quality indicators and interventions subject to programs to control utilization.
  
  
  METHODS
  A large claims database was used to assess copayment changes from 2001 to 2006 for selected drug and non-drug services in patient cohorts with specific chronic diseases.
  
  
  METHODS
  Approximately 5 million commercially-insured individuals enrolled in a variety of fee-for-service and capitated health plans.
  
  
  METHODS
  Copayment trends were calculated as the change in the average amount paid per unit service from 2001 to 2006.
  
  
  RESULTS
  Out-of-pocket payments for services targeted by quality improvement initiatives increased substantially [>50%] and in a similar magnitude to interventions subject to programs to control their use. For prescription drugs, the trend was driven more by copayment increases for branded medications [$10 per prescription] than for generic drugs [$2 per prescription]. Copayments for non-drug preventive services rose modestly.
  
  
  CONCLUSIONS
  Benefit designers should consider reversing the trend of copayment increases for services considered to be indicators of high quality care.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Chernew
authors.forename: Teresa B
authors.initials: TB
authors.lastname: Gibson
authors.forename: A Mark
authors.initials: AM
authors.lastname: Fendrick
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017047:Cost Sharing / Q000191:economics / Q000639:trends*; D016208:Databases, Factual / Q000191:economics / Q000639:trends; D005260:Female; D005102:Health Expenditures / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019984:Quality Indicators, Health Care / Q000191:economics / Q000639:trends*; D055815:Young Adult