Economic Evidence on Cost Sharing and Alternative Insurance Designs to Address Moral and Behavioral Hazards in High-Income Health Care Systems: A Systematic Review
In health insurance, “moral hazard” describes the concept that coverage without an out-of-pocket cost to consumers could result in health care utilization beyond economically efficient levels. In response, payers in the United States (US) have designed pharmaceutical benefit plans with significant c...
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| Format: | Article |
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Taylor & Francis Group
2024-11-01
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| Series: | Journal of Market Access & Health Policy |
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| Online Access: | https://www.mdpi.com/2001-6689/12/4/27 |
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| author | Marlon Graf James R. Baumgardner Ulrich Neumann Iris P. Brewer Jacquelyn W. Chou A. Mark Fendrick |
| author_facet | Marlon Graf James R. Baumgardner Ulrich Neumann Iris P. Brewer Jacquelyn W. Chou A. Mark Fendrick |
| author_sort | Marlon Graf |
| collection | DOAJ |
| description | In health insurance, “moral hazard” describes the concept that coverage without an out-of-pocket cost to consumers could result in health care utilization beyond economically efficient levels. In response, payers in the United States (US) have designed pharmaceutical benefit plans with significant cost exposure (e.g., co-pays, co-insurance, or deductibles). While substantial evidence links patient cost exposure to reduced drug spending, it remains unclear to what degree this translates into greater efficiency or an indiscriminate drop in overall consumption also reducing needed utilization. We conducted a systematic literature review to understand whether commonly implemented utilization management (UM) strategies and insurance designs with a behavioral or value-based (BID/VBID) component have been explored as tools to mitigate moral hazard and to assess how cost-sharing policies and innovative insurance designs impact consumer spending. Eligible studies compared conventional cost-exposure policies to BID/VBID, including tiered cost-sharing and other UM strategies. We found that broad implementation of patient cost exposure is not well supported by empirical evidence assessing efficiency—defined as the use of clinically appropriate services with value at or above the marginal cost of health care utilization in the contemporary US setting. As a result, payers and policy makers alike ought to explore insurance alternatives that more closely align health care consumption incentives to value of care. |
| format | Article |
| id | doaj-art-ab2d94f2a9a5428786e56c56c7da66e0 |
| institution | Kabale University |
| issn | 2001-6689 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Journal of Market Access & Health Policy |
| spelling | doaj-art-ab2d94f2a9a5428786e56c56c7da66e02024-12-27T14:32:44ZengTaylor & Francis GroupJournal of Market Access & Health Policy2001-66892024-11-0112434236810.3390/jmahp12040027Economic Evidence on Cost Sharing and Alternative Insurance Designs to Address Moral and Behavioral Hazards in High-Income Health Care Systems: A Systematic ReviewMarlon Graf0James R. Baumgardner1Ulrich Neumann2Iris P. Brewer3Jacquelyn W. Chou4A. Mark Fendrick5Precision AQ, Bethesda, MD 20814, USAPrecision AQ, Bethesda, MD 20814, USAJohnson & Johnson Innovative Medicine, Titusville, NJ 08560, USAPrecision AQ, Bethesda, MD 20814, USAPrecision AQ, Bethesda, MD 20814, USACenter for Value Based Insurance Design (V-BID), University of Michigan, Ann Arbor, MI 48109, USAIn health insurance, “moral hazard” describes the concept that coverage without an out-of-pocket cost to consumers could result in health care utilization beyond economically efficient levels. In response, payers in the United States (US) have designed pharmaceutical benefit plans with significant cost exposure (e.g., co-pays, co-insurance, or deductibles). While substantial evidence links patient cost exposure to reduced drug spending, it remains unclear to what degree this translates into greater efficiency or an indiscriminate drop in overall consumption also reducing needed utilization. We conducted a systematic literature review to understand whether commonly implemented utilization management (UM) strategies and insurance designs with a behavioral or value-based (BID/VBID) component have been explored as tools to mitigate moral hazard and to assess how cost-sharing policies and innovative insurance designs impact consumer spending. Eligible studies compared conventional cost-exposure policies to BID/VBID, including tiered cost-sharing and other UM strategies. We found that broad implementation of patient cost exposure is not well supported by empirical evidence assessing efficiency—defined as the use of clinically appropriate services with value at or above the marginal cost of health care utilization in the contemporary US setting. As a result, payers and policy makers alike ought to explore insurance alternatives that more closely align health care consumption incentives to value of care.https://www.mdpi.com/2001-6689/12/4/27moral hazardbehavioral hazardvalue-based insuranceefficiencypatient out-of-pocket costspatient cost-sharing |
| spellingShingle | Marlon Graf James R. Baumgardner Ulrich Neumann Iris P. Brewer Jacquelyn W. Chou A. Mark Fendrick Economic Evidence on Cost Sharing and Alternative Insurance Designs to Address Moral and Behavioral Hazards in High-Income Health Care Systems: A Systematic Review Journal of Market Access & Health Policy moral hazard behavioral hazard value-based insurance efficiency patient out-of-pocket costs patient cost-sharing |
| title | Economic Evidence on Cost Sharing and Alternative Insurance Designs to Address Moral and Behavioral Hazards in High-Income Health Care Systems: A Systematic Review |
| title_full | Economic Evidence on Cost Sharing and Alternative Insurance Designs to Address Moral and Behavioral Hazards in High-Income Health Care Systems: A Systematic Review |
| title_fullStr | Economic Evidence on Cost Sharing and Alternative Insurance Designs to Address Moral and Behavioral Hazards in High-Income Health Care Systems: A Systematic Review |
| title_full_unstemmed | Economic Evidence on Cost Sharing and Alternative Insurance Designs to Address Moral and Behavioral Hazards in High-Income Health Care Systems: A Systematic Review |
| title_short | Economic Evidence on Cost Sharing and Alternative Insurance Designs to Address Moral and Behavioral Hazards in High-Income Health Care Systems: A Systematic Review |
| title_sort | economic evidence on cost sharing and alternative insurance designs to address moral and behavioral hazards in high income health care systems a systematic review |
| topic | moral hazard behavioral hazard value-based insurance efficiency patient out-of-pocket costs patient cost-sharing |
| url | https://www.mdpi.com/2001-6689/12/4/27 |
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