title: Mayo Clinic employees responded to new requirements for cost sharing by reducing possibly unneeded health services use.
abstract: Some health plans have experimented with increasing consumer cost sharing, on the theory that consumers will use less unnecessary health care if they are expected to bear some of the financial responsibility for it. However, it is unclear whether the resulting decrease in use is sustained beyond one or two years. In 2004 Mayo Clinic's self-funded health plan increased cost sharing for its employees and their dependents for specialty care visits (adding a $25 copayment to the high-premium option) and other services such as imaging, testing, and outpatient procedures (adding 10 or 20 percent coinsurance, depending on the option). The plan also removed all cost sharing for visits to primary care providers and for preventive services such as colorectal screening and mammography. The result was large decreases in the use of diagnostic testing and outpatient procedures that were sustained for four years, and an immediate decrease in the use of imaging that later rebounded (possibly to levels below the expected trend). Beneficiaries decreased visits to specialists but did not make greater use of primary care services. These results suggest that implementing relatively low levels of cost sharing can lead to a long-term decrease in utilization.
authors: Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA. shah.nilay@mayo.edu
authors: Nilay D
authors: ND
authors: Shah
authors: James M
authors: JM
authors: Naessens
authors: Douglas L
authors: DL
authors: Wood
authors: Robert J
authors: RJ
authors: Stroebel
authors: William
authors: W
authors: Litchy
authors: Amy
authors: A
authors: Wagie
authors: Jiaquan
authors: J
authors: Fan
authors: Robert
authors: R
authors: Nesse
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D017047:Cost Sharing / Q000379:methods*; D005260:Female; D006264:Health Benefit Plans, Employee / Q000191:economics* / Q000458:organization & administration; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D019982:Organizational Case Studies; D019564:Unnecessary Procedures / Q000191:economics*