Co-payment strategies are frequently used by health insurers as a measure of containing healthcare costs. However, co-payments may reduce the use of essential drugs in chronically-ill patients. Recently, value-based insurance designs, where co-payments rates are determined by the value of the treatment, have been introduced in the United States. This review summarizes the results of recent studies in the United States, suggesting that reducing co-payments for highly valued treatments and raising co-payments for less effective treatments can lead to better compliance and better outcomes, with the potential of reducing long-term costs. Further research is needed to examine the feasibility of this approach and the long-term impact on quality of care and treatment costs in other healthcare systems, including Israel.