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Med Care. 2016 Dec;54(12):1050-1055.

Reference Pricing, Consumer Cost-Sharing, and Insurer Spending for Advanced Imaging Tests.

Author information

1
School of Public Health, University of California, Berkeley, Berkeley, CA.

Abstract

BACKGROUND:

Fees charged for similar imaging tests often vary dramatically within the same market, leading to wide variation in insurer spending and consumer cost-sharing. Reference pricing is an insurance design that offers good coverage to patients up to a defined contribution limit but requires the patients who select high-priced facilities to pay the remainder out of pocket.

OBJECTIVES:

To measure the association between implementation of reference pricing and patient choice of facility, test prices, out-of-pocket spending, and insurer spending for advanced imaging (CT and MRI) procedures.

RESEARCH DESIGN:

Difference-in-differences multivariable analysis of insurance claims data. Study included 4751 employees of a national grocery chain (treatment group) and 23,428 enrollees in the nation's largest private insurance plan (comparison group) that used CT or MRI tests between 2010 and 2013.

MEASURES:

Patient choice of facility, price paid per test, patient out-of-pocket cost-sharing, and employer spending.

RESULTS:

Compared with trends in prices paid by insurance enrollees not subject to reference pricing, and after adjusting for characteristics of tests and patients, implementation of reference pricing was associated with a 12.5% (95% CI, -25.0%, 2.1%) reduction in average price paid per test by the end of the second full year of the program for CT scans and a 10.5% (95% CI, -16.9%, 3.6%) for MRIs. Out-of-pocket cost-sharing by patients declined by $71,508 (13.8%). The savings accruing to employees amounted to 45.5% of total savings from reference pricing, with the remainder accruing to the employer.

CONCLUSIONS:

Implementation of reference pricing led to reductions in payments by both employer and employees.

PMID:
27479594
DOI:
10.1097/MLR.0000000000000605
[Indexed for MEDLINE]

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