Do Patient CoPayments Produce Better Health Outcomes?

Rising healthcare expenses in developed nations have made it difficult for many people to seek the medical care they need. From 2011 to 2012, healthcare costs in the United States increased 3.7 percent, costing consumers $2.8 trillion, or $8,915 each person. Some analysts estimated the latest figures to be closer to $3.8 trillion with government spending at a whopping 17.9% of GDP.

Australians spent $132.4 billion on healthcare, while people in the UK spent £24.85 billion. Government expenditure in both these countries sit at between 9-10% of GDP, which may seem more manageable compared to the US, however healthcare leaders in both these countries are taking a firm view of preventing any escalation of these percentages.

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With the high costs of health care around the world, many stakeholders wonder if introducing or adjusting copayments will produce better health outcomes.

The topic is being hotly debated in Australia, where co-payments for General Practitioner visits have been proposed by the Liberal government in its most recent Federal Budget announcement. However, while healthcare stakeholders seem obsessed with costs, the question is do copayments actually improve health outcomes for these nations?

Copayments and Health Outcomes: Is There a Correlation?

Researchers have studied the effects copayments have on health outcomes for many years. The RAND experiment was conducted in the 1970s, but a recent report was prepared for the Kaiser Family Foundation. Jonathan Gruber, Ph.D., from Massachusetts Institute of Technology, examined the RAND experiment and brought to light that high copayments may reduce public health care utilisation, but may not affect their health outcomes. The study followed a broad cross section of people who were rich, poor, sick, healthy, adults, and children.

In a 2010 study published in The New England Journal of Medicine, researchers found the opposite was true for senior citizens. Those that had higher copayments reduced their number of doctor visits. This worsened their illnesses, which resulted in costly hospital care. This was especially true for those who had a low income, lower education, and chronic disease.

Whilst intuitively we may feel that copayments in healthcare may make us value our own health more, these two studies signal that this is not necessarily the case. In fact, higher copays can lead to additional healthcare costs to the health system due to indirectly increasing hospital stays for the elderly.

Those that are not senior citizens may be able to avoid hospital care because they don’t have a high medical risk and hence be less adversely affected by such copayments. In making any conclusions about introducing copayment, we could also take learnings from the relationship of health outcomes and which is another consideration when studying the effects of copayments.

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