Balancing Access and Costs: Health Benefit Structures for Privately Insured People

Health insurance benefit structures, particularly cost-sharing amounts, can either encourage or discourage patients from seeking care. The goal is to strike the right balance so out-of-pocket costs don’t discourage people from getting needed care but do prompt them to consider costs before seeking discretionary care. In 2011, contracts between the International Union, UAW, and Fiat Chrysler, Ford and General Motors significantly changed the structure of autoworker health benefits. Generally, coverage of outpatient physician visits was expanded while additional cost sharing was imposed for emergency department visits unless the patient is admitted to the hospital. A new National Institute for Health Care Reform analysis explores the impact of the autoworker health benefit changes on spending and utilization, providing insights into how benefit structures affect access and costs. Generally, lower patient cost sharing for physician visits resulted in substantially higher overall spending, both as a result of more physician visits as well as increased diagnostic services and procedures. However, higher cost sharing did not significantly decrease emergency department visits or expenditures.