title: Elimination of the Out-of-Pocket Charge for Children's Primary Care Visits: An Application of Value-Based Insurance Design.
abstract: To evaluate the impact of a value-based insurance design for primary care among children.
  
  
  
  A retrospective analysis of health care claims data on 25 950 children (<18 years of age) was conducted. Individuals were enrolled in a large employer's health plans when zero out-of-pocket cost for primary care physician visits was implemented. A rigorous propensity score matching process was used to generate a control group of equal size from a database of other employer-sponsored insurees. Multivariate difference-in-differences models estimated the effect of zero out-of-pocket cost on 21 health services and cost outcomes 24 months after intervention.
  
  
  
  Zero out-of-pocket cost for primary care was associated with significant increases (P < .01) in primary care physician visits (+32 per 100 children), as well as decreases in emergency department (-5 per 100 children) and specialist physician visits (-12 per 100 children). The number of prescription drug fills also declined (-20 per 100 children), yet medication adherence for 3 chronic conditions was unaffected. The receipt of well child visits and 4 recommended vaccinations were all significantly (P < .05) greater under the new plan design feature. Employer costs for primary care increased significantly (P < .01) in association with greater utilization ($29 per child), but specialist visit costs declined (-$12 per child) and total health care costs per child did not exhibit a statistically significant increase.
  
  
  
  This novel application of value-based insurance design warrants broader deployment and assessment of its longer term outcomes. As with recommended preventive services, policymakers should consider exempting primary care from health insurance cost-sharing.
authors.affiliation: IBM Corporation, Yorktown Heights, NY. Electronic address: msepulv119@earthlink.net.
authors.forename: Martín-J
authors.initials: MJ
authors.lastname: Sepúlveda
authors.affiliation: RxEconomics LLC, Hunt Valley, MD.
authors.forename: M Christopher
authors.initials: MC
authors.lastname: Roebuck
authors.affiliation: Employee Benefit Research Institute, Washington, DC.
authors.forename: Paul
authors.initials: P
authors.lastname: Fronstin
authors.affiliation: IBM Corporation, Mexico City, Mexico.
authors.forename: Pablo
authors.initials: P
authors.lastname: Vidales-Calderon
authors.affiliation: Summit Medical Group, Berkeley Heights, NJ.
authors.forename: Ashish
authors.initials: A
authors.lastname: Parikh
authors.affiliation: IBM Corporation, Somers, NY.
authors.forename: Kyu
authors.initials: K
authors.lastname: Rhee
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005102:Health Expenditures; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D011314:Preventive Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics* / Q000706:statistics & numerical data*; D057216:Propensity Score; D012189:Retrospective Studies; D014481:United States; D000070376:Value-Based Health Insurance; D016903:Drug Monitoring
keywords: VBID; cost sharing; employers; health care costs; health insurance; out of pocket costs; primary care; value based insurance design