Can Broader Diffusion of Value-Based Insurance Design Increase Benefits from US Health Care without Increasing Costs? Evidence from a Computer Simulation Model
Identifieur interne : 000605 ( Pmc/Checkpoint ); précédent : 000604; suivant : 000606Can Broader Diffusion of Value-Based Insurance Design Increase Benefits from US Health Care without Increasing Costs? Evidence from a Computer Simulation Model
Auteurs : R. Scott Braithwaite [États-Unis] ; Cynthia Omokaro [États-Unis] ; Amy C. Justice [États-Unis] ; Kimberly Nucifora [États-Unis] ; Mark S. Roberts [États-Unis]Source :
- PLoS Medicine [ 1549-1277 ] ; 2010.
Abstract
Using a computer simulation based on US data, R. Scott Braithwaite and colleagues calculate the benefits of value-based insurance design, in which patients pay less for highly cost-effective services.
Url:
DOI: 10.1371/journal.pmed.1000234
PubMed: 20169114
PubMed Central: 2821897
Affiliations:
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Can Broader Diffusion of Value-Based Insurance Design Increase Benefits from US Health Care without Increasing Costs? Evidence from a Computer Simulation Model</title><author><name sortKey="Scott Braithwaite, R" sort="Scott Braithwaite, R" uniqKey="Scott Braithwaite R" first="R." last="Scott Braithwaite">R. Scott Braithwaite</name><affiliation wicri:level="2"><nlm:aff id="aff1"><addr-line>Section of Value and Comparative Effectiveness, New York University School of Medicine, New York, New York, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Section of Value and Comparative Effectiveness, New York University School of Medicine, New York, New York</wicri:regionArea><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Omokaro, Cynthia" sort="Omokaro, Cynthia" uniqKey="Omokaro C" first="Cynthia" last="Omokaro">Cynthia Omokaro</name><affiliation wicri:level="2"><nlm:aff id="aff2"><addr-line>Albany Medical College, Albany, New York, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Albany Medical College, Albany, New York</wicri:regionArea><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Justice, Amy C" sort="Justice, Amy C" uniqKey="Justice A" first="Amy C." last="Justice">Amy C. Justice</name><affiliation wicri:level="2"><nlm:aff id="aff3"><addr-line>General Internal Medicine, Yale University Schools of Medicine and Public Health, New Haven, Connecticut, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>General Internal Medicine, Yale University Schools of Medicine and Public Health, New Haven, Connecticut</wicri:regionArea><placeName><region type="state">Connecticut</region></placeName></affiliation></author><author><name sortKey="Nucifora, Kimberly" sort="Nucifora, Kimberly" uniqKey="Nucifora K" first="Kimberly" last="Nucifora">Kimberly Nucifora</name><affiliation wicri:level="2"><nlm:aff id="aff1"><addr-line>Section of Value and Comparative Effectiveness, New York University School of Medicine, New York, New York, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Section of Value and Comparative Effectiveness, New York University School of Medicine, New York, New York</wicri:regionArea><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Roberts, Mark S" sort="Roberts, Mark S" uniqKey="Roberts M" first="Mark S." last="Roberts">Mark S. Roberts</name><affiliation wicri:level="2"><nlm:aff id="aff4"><addr-line>Section of Decision Sciences and Clinical Systems Modeling, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Section of Decision Sciences and Clinical Systems Modeling, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania</wicri:regionArea><placeName><region type="state">Pennsylvanie</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff5"><addr-line>Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania</wicri:regionArea><placeName><region type="state">Pennsylvanie</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">20169114</idno><idno type="pmc">2821897</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821897</idno><idno type="RBID">PMC:2821897</idno><idno type="doi">10.1371/journal.pmed.1000234</idno><date when="2010">2010</date><idno type="wicri:Area/Pmc/Corpus">000666</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000666</idno><idno type="wicri:Area/Pmc/Curation">000666</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000666</idno><idno type="wicri:Area/Pmc/Checkpoint">000605</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000605</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Can Broader Diffusion of Value-Based Insurance Design Increase Benefits from US Health Care without Increasing Costs? Evidence from a Computer Simulation Model</title><author><name sortKey="Scott Braithwaite, R" sort="Scott Braithwaite, R" uniqKey="Scott Braithwaite R" first="R." last="Scott Braithwaite">R. Scott Braithwaite</name><affiliation wicri:level="2"><nlm:aff id="aff1"><addr-line>Section of Value and Comparative Effectiveness, New York University School of Medicine, New York, New York, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Section of Value and Comparative Effectiveness, New York University School of Medicine, New York, New York</wicri:regionArea><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Omokaro, Cynthia" sort="Omokaro, Cynthia" uniqKey="Omokaro C" first="Cynthia" last="Omokaro">Cynthia Omokaro</name><affiliation wicri:level="2"><nlm:aff id="aff2"><addr-line>Albany Medical College, Albany, New York, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Albany Medical College, Albany, New York</wicri:regionArea><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Justice, Amy C" sort="Justice, Amy C" uniqKey="Justice A" first="Amy C." last="Justice">Amy C. Justice</name><affiliation wicri:level="2"><nlm:aff id="aff3"><addr-line>General Internal Medicine, Yale University Schools of Medicine and Public Health, New Haven, Connecticut, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>General Internal Medicine, Yale University Schools of Medicine and Public Health, New Haven, Connecticut</wicri:regionArea><placeName><region type="state">Connecticut</region></placeName></affiliation></author><author><name sortKey="Nucifora, Kimberly" sort="Nucifora, Kimberly" uniqKey="Nucifora K" first="Kimberly" last="Nucifora">Kimberly Nucifora</name><affiliation wicri:level="2"><nlm:aff id="aff1"><addr-line>Section of Value and Comparative Effectiveness, New York University School of Medicine, New York, New York, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Section of Value and Comparative Effectiveness, New York University School of Medicine, New York, New York</wicri:regionArea><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Roberts, Mark S" sort="Roberts, Mark S" uniqKey="Roberts M" first="Mark S." last="Roberts">Mark S. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS Med</journal-id><journal-id journal-id-type="iso-abbrev">PLoS Med</journal-id><journal-id journal-id-type="publisher-id">PLoS</journal-id><journal-id journal-id-type="pmc">plosmed</journal-id><journal-title-group><journal-title>PLoS Medicine</journal-title></journal-title-group><issn pub-type="ppub">1549-1277</issn><issn pub-type="epub">1549-1676</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">20169114</article-id><article-id pub-id-type="pmc">2821897</article-id><article-id pub-id-type="publisher-id">09-PLME-RA-1428R3</article-id><article-id pub-id-type="doi">10.1371/journal.pmed.1000234</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline"><subject>Public Health and Epidemiology/Health Policy</subject><subject>Public Health and Epidemiology/Health Services Research and Economics</subject><subject>Public Health and Epidemiology/Preventive Medicine</subject><subject>Public Health and Epidemiology/Screening</subject></subj-group></article-categories><title-group><article-title>Can Broader Diffusion of Value-Based Insurance Design Increase Benefits from US Health Care without Increasing Costs? Evidence from a Computer Simulation Model</article-title><alt-title alt-title-type="running-head">Diffusion of Value-Based Design</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Scott Braithwaite</surname><given-names>R.</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Omokaro</surname><given-names>Cynthia</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Justice</surname><given-names>Amy C.</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Nucifora</surname><given-names>Kimberly</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Roberts</surname><given-names>Mark S.</given-names></name><xref ref-type="aff" rid="aff4"><sup>4</sup></xref><xref ref-type="aff" rid="aff5"><sup>5</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>Section of Value and Comparative Effectiveness, New York University School of Medicine, New York, New York, United States of America</addr-line></aff><aff id="aff2"><label>2</label><addr-line>Albany Medical College, Albany, New York, United States of America</addr-line></aff><aff id="aff3"><label>3</label><addr-line>General Internal Medicine, Yale University Schools of Medicine and Public Health, New Haven, Connecticut, United States of America</addr-line></aff><aff id="aff4"><label>4</label><addr-line>Section of Decision Sciences and Clinical Systems Modeling, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America</addr-line></aff><aff id="aff5"><label>5</label><addr-line>Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States of America</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Salomon</surname><given-names>Joshua A.</given-names></name><role>Academic Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1">Harvard School of Public Health, United States of America</aff><author-notes><corresp id="cor1">* E-mail: <email>Scott.Braithwaite@nyumc.org</email></corresp><fn fn-type="con"><p><ext-link ext-link-type="uri" xlink:href="http://www.icmje.org/">ICMJE</ext-link> criteria for authorship read and met: RSB CO ACJ KN MSR. Agree with the manuscript's results and conclusions: RSB CO ACJ KN MSR. Designed the experiments/the study: RSB CO ACJ MSR. Analyzed the data: RSB KN. Collected data/did experiments for the study: RSB KN. Wrote the first draft of the paper: RSB. Contributed to the writing of the paper: RSB ACJ MSR. Assisted in the development of the model: CO. Implemented the model: KN.</p></fn></author-notes><pub-date pub-type="collection"><month>2</month><year>2010</year></pub-date><pub-date pub-type="epub"><day>16</day><month>2</month><year>2010</year></pub-date><volume>7</volume><issue>2</issue><elocation-id>e1000234</elocation-id><history><date date-type="received"><day>22</day><month>5</month><year>2009</year></date><date date-type="accepted"><day>15</day><month>1</month><year>2010</year></date></history><permissions><copyright-statement>Braithwaite et al.</copyright-statement><copyright-year>2010</copyright-year><license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.</license-p></license></permissions><abstract abstract-type="toc"><p>Using a computer simulation based on US data, R. Scott Braithwaite and colleagues calculate the benefits of value-based insurance design, in which patients pay less for highly cost-effective services.</p></abstract><abstract><sec><title>Background</title><p>Evidence suggests that cost sharing (i.e.,copayments and deductibles) decreases health expenditures but also reduces essential care. Value-based insurance design (VBID) has been proposed to encourage essential care while controlling health expenditures. Our objective was to estimate the impact of broader diffusion of VBID on US health care benefits and costs.</p></sec><sec><title>Methods and Findings</title><p>We used a published computer simulation of costs and life expectancy gains from US health care to estimate the impact of broader diffusion of VBID. Two scenarios were analyzed: (1) applying VBID solely to pharmacy benefits and (2) applying VBID to both pharmacy benefits and other health care services (e.g., devices). We assumed that cost sharing would be eliminated for high-value services (<$100,000 per life-year), would remain unchanged for intermediate- or unknown-value services ($100,000–$300,000 per life-year or unknown), and would be increased for low-value services (>$300,000 per life-year). All costs are provided in 2003 US dollars. Our simulation estimated that approximately 60% of health expenditures in the US are spent on low-value services, 20% are spent on intermediate-value services, and 20% are spent on high-value services. Correspondingly, the vast majority (80%) of health expenditures would have cost sharing that is impacted by VBID. With prevailing patterns of cost sharing, health care conferred 4.70 life-years at a per-capita annual expenditure of US$5,688. Broader diffusion of VBID to pharmaceuticals increased the benefit conferred by health care by 0.03 to 0.05 additional life-years, without increasing costs and without increasing out-of-pocket payments. Broader diffusion of VBID to other health care services could increase the benefit conferred by health care by 0.24 to 0.44 additional life-years, also without increasing costs and without increasing overall out-of-pocket payments. Among those without health insurance, using cost saving from VBID to subsidize insurance coverage would increase the benefit conferred by health care by 1.21 life-years, a 31% increase.</p></sec><sec><title>Conclusion</title><p>Broader diffusion of VBID may amplify benefits from US health care without increasing health expenditures.</p></sec><sec><title></title><p><italic>Please see later in the article for the Editors' Summary</italic></p></sec></abstract><abstract abstract-type="editor"><title>Editors' Summary</title><sec id="s1a1"><title>Background</title><p>More money is spent per person on health care in the US than in any other country. US health care expenditure accounts for 16.2% of the gross domestic product and this figure is rising. Indeed, the increase in health care costs is outstripping the economy's growth rate. Consequently, US policy makers and providers of health insurance—health care in the US is largely provided by the private sector and is paid for through private health insurance or through government programs such as Medicare and Medicaid—are looking for better ways to control health expenditures. Although some health care cost reductions can be achieved by increasing efficiency, controlling the quantity of health care consumed is an essential component of strategies designed to reduce health expenditures. These strategies can target health care providers (for example, by requiring primary care physicians to provide referrals before their patients' insurance provides cover for specialist care) or can target consumers, often through cost sharing. Nowadays, most insurance plans include several tiers of cost sharing in which patients pay a larger proportion of the costs of expensive interventions than of cheap interventions.</p></sec><sec id="s1a2"><title>Why Was This Study Done?</title><p>Cost sharing decreases health expenditure but it can also reduce demand for essential care and thus reduce the quality of care. Consequently, some experts have proposed value-based insurance design (VBID), an approach in which the amount of cost sharing is set according to the “value” of an intervention rather than its cost. The value of an intervention is defined as the ratio of the additional benefits to the additional costs of the intervention when compared to the next best alternative intervention. Under VBID, cost sharing could be waived for office visits necessary to control blood pressure in people with diabetes, which deliver high-value care, but could be increased for high-tech scans for dementia, which deliver low-value care. VBID has been adopted by several private health insurance schemes and its core principal is endorsed by US policy makers. However, it is unclear whether wider use of VBID is warranted. In this study, the researchers use a computer simulation of the US health care system to estimate the impact of broader diffusion of VBID on US health care benefits and costs.</p></sec><sec id="s1a3"><title>What Did the Researchers Do and Find?</title><p>The researchers used their computer simulation to estimate the impact of applying VBID to cost sharing for drugs alone and to cost sharing for drugs, procedures, and other health care services for one million hypothetical US patients. In their simulation, the researchers eliminated cost sharing for services that cost less than US$100,000 per life-year gained (high-value services) and increased cost-sharing for services that cost more than US$300,000 per life-year gained (low-value services); cost-sharing remained unchanged for intermediate- or unknown-value services. With the current pattern of cost sharing, 60% of health expenditure is spent on low-value services and health care increases life expectancy by 4.70 years for an annual per person expenditure of US$5,688, the researchers report. With widespread application of VBID to cost sharing for drugs alone, health care increased life expectancy by an additional 0.03 to 0.05 years without increasing costs. With widespread application of VBID to cost sharing for other health care services, health care increased life expectancy by a further 0.24 to 0.44 years without additional costs. Finally, if the costs saved by applying VBID were used to subsidize insurance for the 15% of the US population currently without health insurance, the benefit conferred by health care among these people would increase by 1.21 life-years.</p></sec><sec id="s1a4"><title>What Do These Findings Mean?</title><p>The findings of this study depend on the many assumptions included in the computer simulation, which, although complex, is a greatly simplified representation of the US health care system. Nevertheless, these findings suggest that if VBID were used more widely within the US health care system to encourage the use of high-value services, it might be possible to amplify the benefits from US health care without increasing health expenditures. Importantly, the money saved by VBID could be used to help fund universal insurance, a central aim of US health care reform. More research is needed, however, to determine the value of various health care interventions and to investigate whether other ways of linking value to cost sharing might yield even better gains in life expectancy at little or no additional cost.</p></sec><sec id="s1a5"><title>Additional Information</title><p>Please access these Web sites via the online version of this summary at <ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.1371/journal.pmed.1000234">http://dx.doi.org/10.1371/journal.pmed.1000234</ext-link>.</p><list list-type="bullet"><list-item><p>Wikipedia has a page on <ext-link ext-link-type="uri" xlink:href="http://en.wikipedia.org/wiki/Health_care_in_the_United_States">health care in the United States</ext-link> (note that Wikipedia is a free online encyclopedia that anyone can edit; available in several languages)</p></list-item><list-item><p><ext-link ext-link-type="uri" xlink:href="http://www.familiesusa.org/">Families USA</ext-link> works to promote high-quality affordable health care for all Americans and provides information about all aspects of US health care and about <ext-link ext-link-type="uri" xlink:href="http://www.familiesusa.org/health-reform-2009/">US health care reforms</ext-link></p></list-item><list-item><p>The <ext-link ext-link-type="uri" xlink:href="http://www.cms.hhs.gov/">US Centers for Medicare and Medicaid</ext-link> provides information on the major government health insurance programs and on <ext-link ext-link-type="uri" xlink:href="http://www.cms.hhs.gov/NationalHealthExpendData/25_NHE_Fact_Sheet.asp">US national health expenditure statistics</ext-link></p></list-item></list></sec></abstract><counts><page-count count="10"></page-count></counts></article-meta></front></pmc><affiliations><list><country><li>États-Unis</li></country><region><li>Connecticut</li><li>Pennsylvanie</li><li>État de New York</li></region></list><tree><country name="États-Unis"><region name="État de New York"><name sortKey="Scott Braithwaite, R" sort="Scott Braithwaite, R" uniqKey="Scott Braithwaite R" first="R." last="Scott Braithwaite">R. Scott Braithwaite</name></region><name sortKey="Justice, Amy C" sort="Justice, Amy C" uniqKey="Justice A" first="Amy C." last="Justice">Amy C. Justice</name><name sortKey="Nucifora, Kimberly" sort="Nucifora, Kimberly" uniqKey="Nucifora K" first="Kimberly" last="Nucifora">Kimberly Nucifora</name><name sortKey="Omokaro, Cynthia" sort="Omokaro, Cynthia" uniqKey="Omokaro C" first="Cynthia" last="Omokaro">Cynthia Omokaro</name><name sortKey="Roberts, Mark S" sort="Roberts, Mark S" uniqKey="Roberts M" first="Mark S." last="Roberts">Mark S. Roberts</name><name sortKey="Roberts, Mark S" sort="Roberts, Mark S" uniqKey="Roberts M" first="Mark S." last="Roberts">Mark S. Roberts</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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