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Rising out-of-pocket costs in disease management programs
Quantitative Health Sciences Publications and Presentations
  • Michael E. Chernew, Harvard Medical School
  • Allison B. Rosen, University of Massachusetts Medical School
  • A. Mark Fendrick, University of Michigan Health Systems
UMMS Affiliation
Department of Quantitative Health Sciences
Publication Date
Document Type
Cost Sharing; *Disease Management; Humans; Managed Care Programs; United States

OBJECTIVES: To document the rise in copayments for patients in disease management programs and to call attention to the inherent conflicts that exist between these 2 approaches to benefit design.

METHODS: Data from 2 large health plans were used to compare cost sharing in disease management programs with cost sharing outside of disease management programs.

RESULTS: The copayments charged to participants in disease management programs usually do not differ substantially from those charged to other beneficiaries.

CONCLUSIONS: Cost sharing and disease management result in conflicting approaches to benefit design. Increasing copayments may lead to underuse of recommended services, thereby decreasing the clinical effectiveness and increasing the overall costs of disease management programs. Policymakers and private purchasers should consider the use of targeted benefit designs when implementing disease management programs or redesigning cost-sharing provisions. Current information systems and health services research are sufficiently advanced to permit these benefit designs.

Am J Manag Care. 2006 Mar;12(3):150-4.
PubMed ID
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Link to Article in PubMed
Citation Information
Michael E. Chernew, Allison B. Rosen and A. Mark Fendrick. "Rising out-of-pocket costs in disease management programs" Vol. 12 Iss. 3 (2006) ISSN: 1088-0224 (Linking)
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