Effects of Introduction of Cost Sharing in Health Insurance Schemes: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

JIA Liying , YUAN Beibei , YANG Bingyi , ZHANG Guojie , CHANG Jie , YU Haining , ZHAO Shichao ,  MENG Qingyue

Centre for Health Management and Policy, Shandong University, Jinan 250012, China;

Corresponding author：

MENG Qingyue, Email: qmeng@sdu.edu.cn

Keywords：

Cost sharing; Health insurance scheme; Systematic review

DOI：

10.7507/1672-2531.20120023

Video：

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Objective 　To systematically review the effects of cost sharing in health insurance schemes, so as to provide evidence for better designing cost sharing ratio in health insurance scheme.
Methods 　The search terms were discussed, tested and then chosen by subject matter experts and search coordinators. The total 20 databases including comprehensive scope, health, economics, sociology, and grey literatures were searched to retrieve all the description or evaluation studies on the effects of cost sharing, such as health services utilization, financial burden or moral hazard. The information from the included studies was extracted into a pre-designed data extraction form, and then it was analyzed and summarized.
Results 　A total of 73 studies were included, covering 17 countries like Australia, Canada, and China, etc. The results of statistical analyses showed that, a) Cost sharing methods were applied to every kind of health insurance scheme. The target population included general population, the elder, the poor, those with chronic disease and children, etc. The services covered clinic, hospitalization, mental health, prevention and drug; and b) The effects brought from cost sharing included: From full fee to cost sharing scheme, the enrollee in developing countries increased their health care utilization, and decreased their financial burden. From full coverage to cost sharing, the utilization of health services decreased in developed countries, but the cost of health insurance could not be reduced, and some undesirable effects were brought due to the decrease of both essential health service utilization and essential drugs compliance.

Citation： JIA Liying,YUAN Beibei,YANG Bingyi,ZHANG Guojie,CHANG Jie,YU Haining,ZHAO Shichao,MENG Qingyue. Effects of Introduction of Cost Sharing in Health Insurance Schemes: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2012, 12(2): 129-141. doi: 10.7507/1672-2531.20120023 Copy

1.	1 Manning WG, Marquis MS. Health insurance: the tradeoff between risk pooling and moral hazard. J Health Econ , 1996, 15(5): 609-639.
2.	Manning WG, Newhouse JP, Duan N, et al . Health insurance and the demand for medical care: evidence from a randomized experiment. Am Econ Rev , 1987, 77(3): 251-277.
3.	Newhouse JP, Manning WG, Morris CN, et al . Some interim results from a controlled trial of cost sharing in health insurance. N Engl J Med , 1981, 305(25): 1501-1507.
4.	Kim J, Ko S, Yang B. The effects of patient cost sharing on ambulatory utilization in South Korea. Health Policy , 2005, 72(3): 293-300.
5.	van Gool K, Savage E, Viney R, et al . Catastrophic insurance: Impact of the Australian Medicare Safety Net on fees, service use and out-of-pocket costs. CHERE, University of Technology, Sydney, 2006.
6.	Grootendorst PV, Marshall JK, Holbrook AM, et al . The Impact of Differential Cost Sharing of Non-Steroidal Anti-Inflammatory Agents on the Use and Costs of Analgesic Drugs. 2004, McMaster University.
7.	Wang PS, Patrick AR, Dormuth CR, et al . The impact of cost sharing on antidepressant use among older adults in British Columbia. Psychiatr Serv , 2008, 59(4): 377-383.
8.	Anis AH, Guh DP, Lacaille D, et al . When patients have to pay a share of drug costs: effects on frequency of physician visits, hospital admissions and filling of prescriptions. CMAJ , 2005, 173(11): 1335-1340.
9.	Wang PS, Patrick AR, Dormuth C, et al . Impact of drug cost sharing on service use and adverse clinical outcomes in elderly receiving antidepressants. J Ment Health Policy Econ , 2010, 13(1): 37-44.
10.	Dormuth CR, Glynn RJ, Neumann P, et al . Impact of two sequential drug cost-sharing policies on the use of inhaled medications in older patients with chronic obstructive pulmonary disease or asthma. Clin Ther , 2006, 28(6): 964-978.
11.	Schneeweiss S, Patrick AR, Maclure M, et al . Adherence to statin therapy under drug cost sharing in patients with and without acute myocardial infarction: a population-based natural experiment. Circulation , 2007, 115(16): 2128-2135.
12.	Tamblyn R, Laprise R, Hanley JA, et al . Adverse events associated with prescription drug cost-sharing among poor and elderly persons. JAMA , 2001, 285(4): 421-429.
13.	Dormuth CR, Neumann P, Maclure M, et al . Effects of prescription coinsurance and income-based deductibles on net health plan spending for older users of inhaled medications. Med Care , 2009, 47(5): 508-516.
14.	Blais L, Couture J, Rahme E, et al . Impact of a cost sharing drug insurance plan on drug utilization among individuals receiving social assistance. Health Policy , 2003, 64(2): 163-172.
15.	Sun X, Jackson S, Carmichael G, et al . Catastrophic medical payment and financial protection in rural China: evidence from the New Cooperative Medical Scheme in Shandong Province. Health Econ , 2009, 18(1): 103-119.
16.	Ruiz F, Amaya L, Venegas S. Progressive segmented health insurance: Colombian health reform and access to health services. Health Econ , 2007, 16(1): 3-18.
17.	Grignon M, Perronnin M, Lavis JN. Does free complementary health insurance help the poor to access health care? Evidence from France. Health Econ , 2008, 17(2): 203-219.
18.	Farbmacher H. Copayments for doctor visits in Germany and the probability of visiting a physician - Evidence from a natural experiment. 2009, University of Munich, Department of Economics.
19.	Augurzky B, Bauer TK, Schaffner S, Copayments in the German health system-Do they work. RWI: Discussion Papers, 2006.
20.	Schmitz H. Do Optional Deductibles Reduce the Number of Doctor Visits? Empirical Evidence with German Data. Ruhr Graduate School in Economics (RGS Econ) and University of Duisburg-Essen, 2008.
21.	Pütz C, Hagist C. Optional deductibles in social health insurance systems: findings from Germany. Eur J Health Econ , 2006, 7(4): 225-230.
22.	Schreyögg J, Grabka MM. Copayments for ambulatory care in Germany: a natural experiment using a difference-in-difference approach. Eur J Health Econ , 2010, 11(3): 331-341.
23.	Schmitt J, Kirch W, Meurer M. Effects of the introduction of the German "Praxisgebühr" on outpatient care and treatment of patients with atopic eczema. J Dtsch Dermatol Ges , 2009, 7(10): 879-886.
24.	Huber CA, Rüesch P, Mielck A, et al . Effects of cost sharing on seeking outpatient care: a propensity-matched study in Germany and Switzerland. J Eval Clin Pract, 2011, doi: 10.1111/j.1365-2753.2011.01679.x. [Epub ahead of print].
25.	Devadasan N, Criel B, Van Damme W, et al . Community health insurance in Gudalur, India, increases access to hospital care. Health Policy Plan , 2010, 25(2): 145-154.
26.	Vardy DA, Freud T, Shvartzman P, et al . Introducing co-payment for consultant specialist services. Isr Med Assoc J , 2006, 8(8): 558-562.
27.	Fiorio CV, Siciliani L. Co-payments and the demand for pharmaceuticals: Evidence from Italy. Economic Modelling , 2010, 27(4): 835-841.
28.	Tracy J. Case study 6. Mobilizing resources for health: the first phase of Kyrgyzstan's co-payment policy. Health systems confront poverty, edited by Erio Ziglio, Rogerio Barbosa, Yves Charpak, Steve Turner, 2003: 79-92.
29.	Schneider P, Hanson K. Horizontal equity in utilisation of care and fairness of health financing: a comparison of micro-health insurance and user fees in Rwanda. Health Econ , 2006, 15(1): 19-31.
30.	Saksena P, Antunes AF, Xu K, et al . Mutual health insurance in Rwanda: evidence on access to care and financial risk protection. Health Policy , 2011, 99(3): 203-209.
31.	Schellhorn M. The effect of variable health insurance deductibles on the demand for physician visits. Health Econ , 2001, 10(5): 441-456.
32.	Chen CS, Liu TC, Lin HC, et al . The effect of Taiwan's National Health Insurance on infants' preventive care use and inpatient care use. Health Policy , 2007, 80(3): 432-443. 33 Cheng SH, Chiang TL. The effect of universal health insurance on health care utilization in Taiwan. Results from a natural experiment. JAMA , 1997, 278(2): 89-93.
33.	Chu HL, Liu SZ, Romeis JC. The Effects of Physicians’Financial Incentives on the Effectiveness of Taiwan's Outpatient Drug Copayment Policy. Drug Information Journal , 2008, 42: 493-502.
34.	Liu SZ, Romeis JC. Assessing the effect of Taiwan's outpatient prescription drug copayment policy in the elderly. Med Care , 2003, 41(12): 1331-1342.
35.	Lu JF, Hsiao WC. Does universal health insurance make health care unaffordable? Lessons from Taiwan. Health Aff (Millwood) , 2003, 22(3): 77-88.
36.	Kipp W, Kamugisha J, Jacobs P, et al . User fees, health staff incentives, and service utilization in Kabarole District, Uganda. Bull World Health Organ , 2001, 79(11): 1032-1037.
37.	Burnham GM, Pariyo G, Galiwango E, et al . Discontinuation of cost sharing in Uganda. Bull World Health Organ , 2004, 82(3): 187-195.
38.	Selby JV, Fireman BH, Swain BE. Effect of a copayment on use of the emergency department in a health maintenance organization. N Engl J Med , 1996, 334(10): 635-641.
39.	Phelps CE, Newhouse JP. Effect of coinsurance: A multivariate analysis. Bulletin of the World Health Organization, 1972.
40.	Trivedi AN, Rakowski W, Ayanian JZ. Effect of cost sharing on screening mammography in Medicare health plans. N Engl J Med , 2008, 358(4): 375-383.
41.	Hayami DE, Freeborn DK. Effect of coverage on use of an HMO alcoholism treatment program, outcome, and medical care utilization. Am J Public Health , 1981, 71(10): 1133-1143.
42.	Roblin DW, Platt R, Goodman MJ, et al . Effect of increased cost-sharing on oral hypoglycemic use in five managed care organizations: how much is too much? Med Care , 2005, 43(10): 951-959.
43.	Wong MD, Andersen R, Sherbourne CD, et al . Effects of cost sharing on care seeking and health status: results from the Medical Outcomes Study. Am J Public Health , 2001, 91(11): 1889-1894.
44.	Wharam JF, Landon BE, Galbraith AA, et al . Emergency department use and subsequent hospitalizations among members of a high-deductible health plan. JAMA , 2007, 297(10): 1093-1102.
45.	Lowe RA, Fu R, Gallia CA. Impact of policy changes on emergency department use by Medicaid enrollees in Oregon. Med Care , 2010, 48(7): 619-627.
46.	Simon GE, Grothaus L, Durham ML, et al . Impact of visit copayments on outpatient mental health utilization by members of a health maintenance organization. Am J Psychiatry , 1996, 153(3): 331-338.
47.	Wallen J, Roddy P, Meyers SM. Male-female differences in mental health visits under cost-sharing. Health Serv Res , 1986, 21(2 Pt 2): 341-350.
48.	Harris BL, Stergachis A, Ried LD, The effect of drug co-payments on utilization and cost of pharmaceuticals in a health maintenance organization. Medical Care , 1990, 28(10): 907-917.
49.	Guy GP Jr. The effects of cost sharing on access to care among childless adults. Health Serv Res , 2010, 45(6 Pt 1): 1720-1739.
50.	Fischer PJ, Strobino DM, Pinckney CA. Utilization of child health clinics following introduction of a copayment. Am J Public Health , 1984, 74(12): 1401-1403.
51.	Hsu J, Price M, Brand R, et al . Cost-sharing for emergency care and unfavorable clinical events: findings from the safety and financial ramifications of ED copayments study. Health Serv Res , 2006, 41(5): 1801-1820.
52.	Reeder CE, Nelson AA. The differential impact of copayment on drug use in a Medicaid population. Inquiry , 1985, 22(4): 396-403.
53.	Reed M, Fung V, Brand R, et al . Care-seeking behavior in response to emergency department copayments. Med Care , 2005, 43(8): 810-816.
54.	Newhouse JP. Cost Sharing for Medical Care Services. The Rand Corporation, 1984.
55.	Saito E, Davis J, Mau M, et al . Copayment level and drug switching: Findings for type 2 diabetes. Am J Pharm Benefits , 2010. 2(6): 412-420.
56.	Helms J, Newhouse JP, Phelps CE. Copayments and Demand for Medical Care: The California Medicaid Experience. Bell Journal of Economics , 1978, 9(1): 192-208.
57.	Greene SB, Gunselman DL. Cost sharing and its effects on hospital utilization. The Blue Cross and Blue Shield of North Carolina experience. Med Care , 1986, 24(8): 711-720.
58.	Hopkins CE, Roemer MI, Procter DM, et al . Cost-sharing and prior authorization effects on Medicaid services in California: part I. The beneficiaries' reactions. Med Care , 1975, 13(7): 582-594.
59.	Anderson GM, Brook R, Williams A. A comparison of cost-sharing versus free care in children: effects on the demand for office-based medical care. Med Care , 1991, 29(9): 890-898.
60.	Roemer MI, Hopkins CE, Carr L, et al . Copayments for ambulatory care: penny-wise and pound-foolish. Med Care , 1975, 13(6): 457-466.
61.	Wolfson J, Kapadia AS, Decker M, et al . Effects of cost-sharing on users of a state's health service program. Med Care , 1982, 20(12): 1178-1187.
62.	Nelson AA Jr, Reeder CE, Dickson WM. The effect of a Medicaid drug copayment program on the utilization and cost of prescription services. Med Care , 1984, 22(8): 724-736.
63.	Lowe RA, McConnell KJ, Fu R, et al . Changes in access to primary care for Medicaid beneficiaries and the uninsured: the emergency department perspective. Am J Emerg Med , 2006, 24(1): 33-37.
64.	Fairman KA, Motheral BR, Henderson RR. Retrospective, long-term follow-up study of the effect of a three-tier prescription drug copayment system on pharmaceutical and other medical utilization and costs. Clin Ther , 2003, 25(12): 3147-3161.
65.	Kim E, Gupta S, Bolge SC, et al . The association of copay burden and outcomes among patients with schizophrenia. In: ISPOR 14th Annual International Meeting. Orlando, FL, USA; 2009.
66.	Wallace NT, McConnell KJ, Gallia CA, et al . How effective are copayments in reducing expenditures for low-income adult Medicaid beneficiaries? Experience from the Oregon health plan. Health Serv Res , 2008, 43(2): 515-530.
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71.	Schneeweiss S, Patrick AR, Maclure M, et al . Adherence to beta-blocker therapy under drug cost-sharing in patients with and without acute myocardial infarction. Am J Manag Care , 2007, 13(8): 445-452.
72.	Li X, Guh D, Lacaille D, et al . The impact of cost sharing of prescription drug expenditures on health care utilization by the elderly: own- and cross-price elasticities. Health Policy , 2007, 82(3): 340-347.
73.	Manning WG, Newhouse JP, Duan N, et al . Health insurance and the demand for medical care: evidence from a randomized experiment. Am Econ Rev , 1987, 77(3): 251-277.
74.	Manning WG, Bailit HL, Benjamin B, et al . The demand for dental care: evidence from a randomized trial in health insurance. J Am Dent Assoc , 1985, 110(6): 895-902.
75.	Foxman B, Valdez RB, Lohr KN, et al . The effect of cost sharing on the use of antibiotics in ambulatory care: results from a population-based randomized controlled trial. J Chronic Dis , 1987, 40(5): 429-437.
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80.	Manning WG Jr, Wells KB, Duan N, et al . How cost sharing affects the use of ambulatory mental health services. JAMA , 1986, 256(14): 1930-1934.
81.	Waters TM, Chang CF, Cecil WT, et al . Impact of high-deductible health plans on health care utilization and costs. Health Serv Res , 2011, 46(1 Pt 1): 155-172.
82.	Karter AJ, Parker MM, Moffet HH, et al . Effect of cost-sharing changes on self-monitoring of blood glucose. Am J Manag Care , 2007, 13(7): 408-416.

1. 1 Manning WG, Marquis MS. Health insurance: the tradeoff between risk pooling and moral hazard. J Health Econ , 1996, 15(5): 609-639.
2. Manning WG, Newhouse JP, Duan N, et al . Health insurance and the demand for medical care: evidence from a randomized experiment. Am Econ Rev , 1987, 77(3): 251-277.
3. Newhouse JP, Manning WG, Morris CN, et al . Some interim results from a controlled trial of cost sharing in health insurance. N Engl J Med , 1981, 305(25): 1501-1507.
4. Kim J, Ko S, Yang B. The effects of patient cost sharing on ambulatory utilization in South Korea. Health Policy , 2005, 72(3): 293-300.
5. van Gool K, Savage E, Viney R, et al . Catastrophic insurance: Impact of the Australian Medicare Safety Net on fees, service use and out-of-pocket costs. CHERE, University of Technology, Sydney, 2006.
6. Grootendorst PV, Marshall JK, Holbrook AM, et al . The Impact of Differential Cost Sharing of Non-Steroidal Anti-Inflammatory Agents on the Use and Costs of Analgesic Drugs. 2004, McMaster University.
7. Wang PS, Patrick AR, Dormuth CR, et al . The impact of cost sharing on antidepressant use among older adults in British Columbia. Psychiatr Serv , 2008, 59(4): 377-383.
8. Anis AH, Guh DP, Lacaille D, et al . When patients have to pay a share of drug costs: effects on frequency of physician visits, hospital admissions and filling of prescriptions. CMAJ , 2005, 173(11): 1335-1340.
9. Wang PS, Patrick AR, Dormuth C, et al . Impact of drug cost sharing on service use and adverse clinical outcomes in elderly receiving antidepressants. J Ment Health Policy Econ , 2010, 13(1): 37-44.
10. Dormuth CR, Glynn RJ, Neumann P, et al . Impact of two sequential drug cost-sharing policies on the use of inhaled medications in older patients with chronic obstructive pulmonary disease or asthma. Clin Ther , 2006, 28(6): 964-978.
11. Schneeweiss S, Patrick AR, Maclure M, et al . Adherence to statin therapy under drug cost sharing in patients with and without acute myocardial infarction: a population-based natural experiment. Circulation , 2007, 115(16): 2128-2135.
12. Tamblyn R, Laprise R, Hanley JA, et al . Adverse events associated with prescription drug cost-sharing among poor and elderly persons. JAMA , 2001, 285(4): 421-429.
13. Dormuth CR, Neumann P, Maclure M, et al . Effects of prescription coinsurance and income-based deductibles on net health plan spending for older users of inhaled medications. Med Care , 2009, 47(5): 508-516.
14. Blais L, Couture J, Rahme E, et al . Impact of a cost sharing drug insurance plan on drug utilization among individuals receiving social assistance. Health Policy , 2003, 64(2): 163-172.
15. Sun X, Jackson S, Carmichael G, et al . Catastrophic medical payment and financial protection in rural China: evidence from the New Cooperative Medical Scheme in Shandong Province. Health Econ , 2009, 18(1): 103-119.
16. Ruiz F, Amaya L, Venegas S. Progressive segmented health insurance: Colombian health reform and access to health services. Health Econ , 2007, 16(1): 3-18.
17. Grignon M, Perronnin M, Lavis JN. Does free complementary health insurance help the poor to access health care? Evidence from France. Health Econ , 2008, 17(2): 203-219.
18. Farbmacher H. Copayments for doctor visits in Germany and the probability of visiting a physician - Evidence from a natural experiment. 2009, University of Munich, Department of Economics.
19. Augurzky B, Bauer TK, Schaffner S, Copayments in the German health system-Do they work. RWI: Discussion Papers, 2006.
20. Schmitz H. Do Optional Deductibles Reduce the Number of Doctor Visits? Empirical Evidence with German Data. Ruhr Graduate School in Economics (RGS Econ) and University of Duisburg-Essen, 2008.
21. Pütz C, Hagist C. Optional deductibles in social health insurance systems: findings from Germany. Eur J Health Econ , 2006, 7(4): 225-230.
22. Schreyögg J, Grabka MM. Copayments for ambulatory care in Germany: a natural experiment using a difference-in-difference approach. Eur J Health Econ , 2010, 11(3): 331-341.
23. Schmitt J, Kirch W, Meurer M. Effects of the introduction of the German "Praxisgebühr" on outpatient care and treatment of patients with atopic eczema. J Dtsch Dermatol Ges , 2009, 7(10): 879-886.
24. Huber CA, Rüesch P, Mielck A, et al . Effects of cost sharing on seeking outpatient care: a propensity-matched study in Germany and Switzerland. J Eval Clin Pract, 2011, doi: 10.1111/j.1365-2753.2011.01679.x. [Epub ahead of print].
25. Devadasan N, Criel B, Van Damme W, et al . Community health insurance in Gudalur, India, increases access to hospital care. Health Policy Plan , 2010, 25(2): 145-154.
26. Vardy DA, Freud T, Shvartzman P, et al . Introducing co-payment for consultant specialist services. Isr Med Assoc J , 2006, 8(8): 558-562.
27. Fiorio CV, Siciliani L. Co-payments and the demand for pharmaceuticals: Evidence from Italy. Economic Modelling , 2010, 27(4): 835-841.
28. Tracy J. Case study 6. Mobilizing resources for health: the first phase of Kyrgyzstan's co-payment policy. Health systems confront poverty, edited by Erio Ziglio, Rogerio Barbosa, Yves Charpak, Steve Turner, 2003: 79-92.
29. Schneider P, Hanson K. Horizontal equity in utilisation of care and fairness of health financing: a comparison of micro-health insurance and user fees in Rwanda. Health Econ , 2006, 15(1): 19-31.
30. Saksena P, Antunes AF, Xu K, et al . Mutual health insurance in Rwanda: evidence on access to care and financial risk protection. Health Policy , 2011, 99(3): 203-209.
31. Schellhorn M. The effect of variable health insurance deductibles on the demand for physician visits. Health Econ , 2001, 10(5): 441-456.
32. Chen CS, Liu TC, Lin HC, et al . The effect of Taiwan's National Health Insurance on infants' preventive care use and inpatient care use. Health Policy , 2007, 80(3): 432-443. 33 Cheng SH, Chiang TL. The effect of universal health insurance on health care utilization in Taiwan. Results from a natural experiment. JAMA , 1997, 278(2): 89-93.
33. Chu HL, Liu SZ, Romeis JC. The Effects of Physicians’Financial Incentives on the Effectiveness of Taiwan's Outpatient Drug Copayment Policy. Drug Information Journal , 2008, 42: 493-502.
34. Liu SZ, Romeis JC. Assessing the effect of Taiwan's outpatient prescription drug copayment policy in the elderly. Med Care , 2003, 41(12): 1331-1342.
35. Lu JF, Hsiao WC. Does universal health insurance make health care unaffordable? Lessons from Taiwan. Health Aff (Millwood) , 2003, 22(3): 77-88.
36. Kipp W, Kamugisha J, Jacobs P, et al . User fees, health staff incentives, and service utilization in Kabarole District, Uganda. Bull World Health Organ , 2001, 79(11): 1032-1037.
37. Burnham GM, Pariyo G, Galiwango E, et al . Discontinuation of cost sharing in Uganda. Bull World Health Organ , 2004, 82(3): 187-195.
38. Selby JV, Fireman BH, Swain BE. Effect of a copayment on use of the emergency department in a health maintenance organization. N Engl J Med , 1996, 334(10): 635-641.
39. Phelps CE, Newhouse JP. Effect of coinsurance: A multivariate analysis. Bulletin of the World Health Organization, 1972.
40. Trivedi AN, Rakowski W, Ayanian JZ. Effect of cost sharing on screening mammography in Medicare health plans. N Engl J Med , 2008, 358(4): 375-383.
41. Hayami DE, Freeborn DK. Effect of coverage on use of an HMO alcoholism treatment program, outcome, and medical care utilization. Am J Public Health , 1981, 71(10): 1133-1143.
42. Roblin DW, Platt R, Goodman MJ, et al . Effect of increased cost-sharing on oral hypoglycemic use in five managed care organizations: how much is too much? Med Care , 2005, 43(10): 951-959.
43. Wong MD, Andersen R, Sherbourne CD, et al . Effects of cost sharing on care seeking and health status: results from the Medical Outcomes Study. Am J Public Health , 2001, 91(11): 1889-1894.
44. Wharam JF, Landon BE, Galbraith AA, et al . Emergency department use and subsequent hospitalizations among members of a high-deductible health plan. JAMA , 2007, 297(10): 1093-1102.
45. Lowe RA, Fu R, Gallia CA. Impact of policy changes on emergency department use by Medicaid enrollees in Oregon. Med Care , 2010, 48(7): 619-627.
46. Simon GE, Grothaus L, Durham ML, et al . Impact of visit copayments on outpatient mental health utilization by members of a health maintenance organization. Am J Psychiatry , 1996, 153(3): 331-338.
47. Wallen J, Roddy P, Meyers SM. Male-female differences in mental health visits under cost-sharing. Health Serv Res , 1986, 21(2 Pt 2): 341-350.
48. Harris BL, Stergachis A, Ried LD, The effect of drug co-payments on utilization and cost of pharmaceuticals in a health maintenance organization. Medical Care , 1990, 28(10): 907-917.
49. Guy GP Jr. The effects of cost sharing on access to care among childless adults. Health Serv Res , 2010, 45(6 Pt 1): 1720-1739.
50. Fischer PJ, Strobino DM, Pinckney CA. Utilization of child health clinics following introduction of a copayment. Am J Public Health , 1984, 74(12): 1401-1403.
51. Hsu J, Price M, Brand R, et al . Cost-sharing for emergency care and unfavorable clinical events: findings from the safety and financial ramifications of ED copayments study. Health Serv Res , 2006, 41(5): 1801-1820.
52. Reeder CE, Nelson AA. The differential impact of copayment on drug use in a Medicaid population. Inquiry , 1985, 22(4): 396-403.
53. Reed M, Fung V, Brand R, et al . Care-seeking behavior in response to emergency department copayments. Med Care , 2005, 43(8): 810-816.
54. Newhouse JP. Cost Sharing for Medical Care Services. The Rand Corporation, 1984.
55. Saito E, Davis J, Mau M, et al . Copayment level and drug switching: Findings for type 2 diabetes. Am J Pharm Benefits , 2010. 2(6): 412-420.
56. Helms J, Newhouse JP, Phelps CE. Copayments and Demand for Medical Care: The California Medicaid Experience. Bell Journal of Economics , 1978, 9(1): 192-208.
57. Greene SB, Gunselman DL. Cost sharing and its effects on hospital utilization. The Blue Cross and Blue Shield of North Carolina experience. Med Care , 1986, 24(8): 711-720.
58. Hopkins CE, Roemer MI, Procter DM, et al . Cost-sharing and prior authorization effects on Medicaid services in California: part I. The beneficiaries' reactions. Med Care , 1975, 13(7): 582-594.
59. Anderson GM, Brook R, Williams A. A comparison of cost-sharing versus free care in children: effects on the demand for office-based medical care. Med Care , 1991, 29(9): 890-898.
60. Roemer MI, Hopkins CE, Carr L, et al . Copayments for ambulatory care: penny-wise and pound-foolish. Med Care , 1975, 13(6): 457-466.
61. Wolfson J, Kapadia AS, Decker M, et al . Effects of cost-sharing on users of a state's health service program. Med Care , 1982, 20(12): 1178-1187.
62. Nelson AA Jr, Reeder CE, Dickson WM. The effect of a Medicaid drug copayment program on the utilization and cost of prescription services. Med Care , 1984, 22(8): 724-736.
63. Lowe RA, McConnell KJ, Fu R, et al . Changes in access to primary care for Medicaid beneficiaries and the uninsured: the emergency department perspective. Am J Emerg Med , 2006, 24(1): 33-37.
64. Fairman KA, Motheral BR, Henderson RR. Retrospective, long-term follow-up study of the effect of a three-tier prescription drug copayment system on pharmaceutical and other medical utilization and costs. Clin Ther , 2003, 25(12): 3147-3161.
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Chinese Journal of Evidence-Based Medicine

Effects of Introduction of Cost Sharing in Health Insurance Schemes: A Systematic Review

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