A buzzword circulating in the health policy world is value-based insurance design. This phrase sounds like something the business world might latch on to. It sounds very businessy–companies in control of maximizing shareholder value.
Two studies were published in Health Affairs dealing with aspects of this approach. They studied the effect of lowering copayments for medications on adherence: i.e. how often patients took the medicines. One study eliminated copayments for generic medications and lowered them for brand-name drugs. It found adherence improved 1.5% to 3.8%, depending on the drug. The other study eliminated copayments for statins and reduced them for clopidogrel (Plavix), and found adherence increased 2.8% for statins and 4% for clopidogrel a year later.
These studies remind us that adherence is a complicated issue and show that lowering co-pays helps very little. The other striking aspect of these articles is that they give no indication that the authors realize that by encouraging their employees to take more medicines and spending money to do so, in most cases they are raising the total cost of healthcare for the company.
Finally, supporters could point out that this experiment resulted in improved quality of care. This reminds us of another reality — higher quality care usually costs more; or to phrase it another way, if you want something better, it will cost you.