That is the paraphrased title of a paper by Fusco et al. (2023). The authors conduct a scientific literature overview of research printed between 2010 and 2020 and discover that among the many 79 articles screened:
Nearly all of publications discovered that, no matter illness space, elevated cost-sharing was related to worse adherence, persistence, or discontinuation. The mixture knowledge recommended the better the magnitude of cost-sharing, the more severe the adherence. Amongst research analyzing scientific outcomes, cost-sharing was related to worse outcomes in 1 examine and the remaining 3 discovered no important variations. Concerning HRU [healthcare resource utilization], higher-cost-sharing trended towards decreased outpatient and elevated inpatient utilization. The accessible proof recommended greater cost-sharing has an total impartial to unfavorable affect on whole prices. Research evaluating elimination of copays discovered both decreased or no affect in whole prices.
There are two problem with the paper (i) publication bias and (ii) value sharing measurement. With respect to the previous, are papers that present no relationship between value sharing and adherence, HRU and price much less more likely to be printed? Probably. Whereas this bias doubtless would affect the purpose estimates, it appears logically and empirically very sturdy that greater value sharing reduces adherence and will increase inpatient admissions. Publication bias could also be extra influential for the opposite outcomes measured (i.e., scientific outcomes and price). The second problem is that value sharing could also be measured in numerous methods throughout research. The authors do point out that the sort and magnitude of value sharing various throughout research. Extra importantly, nevertheless, the connection between value sharing and outcomes is troublesome to estimate empirically since what one wish to measure is the associated fee sharing construction a affected person faces; in the event you don’t fill a drug as a result of value sharing is just too excessive, noticed copayments within the knowledge might be $0 however the true value sharing one faces is giant. However, if an individual has low value sharing, they could resolve the fill the drug and noticed value sharing (as measured in claims) can be excessive even when the profit design may be very beneficiant. Since claims knowledge solely embody quantities paid relatively than a affected person’s profit construction, inventive econometric options–or knowledge that mix claims and profit design–are wanted to estimate the connection between value sharing and price in a extra rigorous method. However, by conducting a scientific literature overview of those research, Fusco and co-authors have supplied an necessary overview for researchers to judge these points for particular person research in additional element.
