Working Paper: NBER ID: w22875
Authors: Jonathan Gruber; Johanna Catherine Maclean; Bill J. Wright; Eric S. Wilkinson; Kevin Volpp
Abstract: In this study we examine the impact of a value-based insurance design (V-BID) program implemented between 2010 and 2013 at a large public employer in the state of Oregon. The program substantially increased cost-sharing, specifically copayments and coinsurance, for several healthcare services believed to be of low value and overused (sleep studies, endoscopies, advanced imaging, and surgeries). Using a differences-in-differences design coupled with granular, administrative health insurance claims data, we estimate the change in low value healthcare service utilization among beneficiaries before and after program implementation relative to a comparison group of beneficiaries who were not exposed to the V-BID. Our findings suggest that the V-BID significantly reduced utilization of targeted services. These findings have important implications for both public and private healthcare policies as V-BID principles are rapidly proliferating in healthcare markets.
Keywords: Value-Based Insurance Design; Cost-Sharing; Low-Value Healthcare Services
JEL Codes: I11; I13
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| employee awareness of the VBID program (I13) | utilization of targeted low-value healthcare services (I11) |
| VBID program implementation (I18) | utilization of targeted low-value healthcare services (I11) |
| increased patient cost-sharing (H51) | utilization of targeted low-value healthcare services (I11) |
| cost-sharing increases (H51) | utilization of sleep studies (I11) |
| cost-sharing increases (H51) | utilization of endoscopies (I10) |
| cost-sharing increases (H51) | utilization of advanced imaging services (I11) |