The growth in health care spending is slowing down, and one reason might be that cost sharing is rising.

The proportion of insured workers with at least a $1,000 deductible was 41 percent in 2014, quadruple that in 2006. Hidden in the numbers is the fact that increasing cost sharing for patients with chronic illnesses can backfire, causing their health care spending to go up, not down.

When patients face higher cost sharing for prescription drugs, they tend to cut back on them. That’s a finding from a recent study from the National Bureau of Economic Research by Peter Huckfeldt and colleagues, who examined employer-based health plan enrollees who use drugs to treat high cholesterol, hypertension and diabetes. They even found that patients cut their drug use when drugs were exempt from the deductible. Perhaps they did so because they did not understand the drugs had no deductible. They may also have cut back on visiting the doctor to get a prescription because the visits were subject to the deductible.

These kinds of cuts in care can be especially problematic for patients with more severe illnesses. A number of studies document the adverse effects of cost sharing on sicker patients. When applied indiscriminately, cost sharing can hurt the sicker patients by prompting them to delay or avoid the preventive care they need. A 2012 study showed that higher cost sharing reduces spending on physician visits and drugs, but can increase hospital spending. When Medicare beneficiaries face higher cost sharing, hospitalizations go up, not down, especially for those with chronic illnesses.

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Jeffrey R. Ungvary President

Jeffrey R. Ungvary