That is the paraphrased title of a paper by Fusco et al. (2023). The authors conduct a scientific literature evaluate of research revealed 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 combination knowledge urged the better the magnitude of cost-sharing, the more severe the adherence. Amongst research analyzing medical outcomes, cost-sharing was related to worse outcomes in 1 examine and the remaining 3 discovered no important variations. Relating to HRU [healthcare resource utilization], higher-cost-sharing trended towards decreased outpatient and elevated inpatient utilization. The obtainable proof urged increased cost-sharing has an total impartial to detrimental impression on complete prices. Research evaluating elimination of copays discovered both decreased or no impression in complete 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 prone to be revealed? Probably. Whereas this bias doubtless would impression the purpose estimates, it appears logically and empirically very robust that increased value sharing reduces adherence and will increase inpatient admissions. Publication bias could also be extra influential for the opposite outcomes measured (i.e., medical 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 assorted throughout research. Extra importantly, nonetheless, the connection between value sharing and outcomes is tough to estimate empirically since what one want to measure is the associated fee sharing construction a affected person faces; when you don’t fill a drug as a result of value sharing is simply too excessive, noticed copayments within the knowledge will likely be $0 however the true value sharing one faces is giant. Then again, if an individual has low value sharing, they could determine 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 somewhat than a affected person’s profit construction, artistic 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 evaluate of those research, Fusco and co-authors have supplied an necessary evaluate for researchers to judge these points for particular person research in additional element.
