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The American Journal of Managed Care April 2010
Estimated Effect of Asthma Case Management Using Propensity Score Methods
Sylvia Brandt, PhD; Sara Gale, MPH; and Ira B. Tager, MD, MPH
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John P. Jameson, PharmD; and Philip J. Baty, MD
Age and Rural Residence Effects on Accessing Colorectal Cancer Treatments: A Registry Study
Jayashri Sankaranarayanan, PhD; Shinobu Watanabe-Galloway, PhD; Junfeng Sun, PhD; Fang Qiu, MS, PhD; Eugene C. Boilesen, BS; and Alan G. Thorson, MD
Low-Value Services in Value-Based Insurance Design
Peter J. Neumann, ScD; Hannah R. Auerbach, BA; Joshua T. Cohen, PhD; and Dan Greenberg, PhD
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Tomas J. Philipson, PhD; Essy Mozaffari, PharmD, MPH; and John Ross Maclean, MD
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Dean G. Smith, PhD
Relationship Between High Cost Sharing and Adverse Outcomes: A Truism That's Tough to Prove
Niteesh K. Choudhry, MD, PhD
Currently Reading
Knowledge of Cost Sharing and Decisions to Seek Care
Amy M. Lischko, DSc; and James F. Burgess Jr, PhD
Health Information Technology and Physicians' Knowledge of Drug Costs
Chien-Wen Tseng, MD, MPH; Robert H. Brook, MD, ScD; G. Caleb Alexander, MD, MS; Allen L. Hixon, MD; Emmett B. Keeler, PhD; Carol M. Mangione, MD, MSPH; Randi Chen, MS; Eric A. Jackson, PharmD; and R. Adams Dudley, MD, MBA
The National Oncology Working Group (NOW) Initiative: Payer and Provider Collaborations in Oncology Benefits Management
Aileen M. Soper, BA; C. E. (Gene) Reeder, RPh, PhD; Loreen M. Brown, MSW; Ana Stojanovska, BS; and Barbara J. Lennert, RN, BSN, MAOM

Knowledge of Cost Sharing and Decisions to Seek Care

Amy M. Lischko, DSc; and James F. Burgess Jr, PhD

Educating employees about their cost-sharing responsibilities could lead to more efficient use of the healthcare system.

Objectives: To assess knowledge and understanding of cost-sharing responsibilities and whether that knowledge and understanding influence actual and perceived use of healthcare services.


Study Design: A 3000-person random sample was drawn from a state employee database in Massachusetts.


Methods: Survey responses and claims analyses were used to assess knowledge of cost sharing and healthcare utilization over a 3-year study period. Trend models and logistic regression were used.


Results: Nearly two-thirds of respondents (62%) accurately recalled the percentage of premium that they paid; 67% recalled the correct copayment for a doctor’s visit. Younger, less educated, and lower-income employees recalled their copayment more accurately than older, more educated, higher-income colleagues. Half of the respondents accurately reported the copayment amount for an emergency department visit. Greater knowledge of overall healthcare costs was positively associated with higher utilization of office visits (P <.01). Knowledge of specific office visit and emergency department copayments had no significant relationship with utilization. Self-reported delays and reductions in utilization were much more pronounced than the actual claims data indicated.


Conclusions: Employees were reasonably well informed about their cost-sharing responsibilities. Knowledge of costs was associated with higher office visit utilization during the study period. Respondents who were more knowledgeable about their specific copayments for office visits and emergency department visits also were more likely to behave in what appeared to be a more cost-efficient manner, with more office visits and fewer emergency department visits.


(Am J Manag Care. 2010;16(4):298-304)

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