By Keanan Lane

A recent study appearing in JAMA provides further insight into the effects of cost sharing on patients with chronic illnesses, finding that higher amounts resulted in greater delays of necessary treatments.

Parents were surveyed about financial pressure they felt in treating their children’s asthma and whether, in the presence of financial pressure, they altered the medication or dosage, delayed a physician visit, borrowed money, or had cut back on some necessities.  Researchers then compared the percentages of parents who adjusted their behavior based on insurance type, income, and cost-sharing categories.

Parents in a high cost-sharing plan were more likely to avoid, delay, and lower treatment for their child’s asthma. Cost responses were primarily experienced within the commercially insured group for those with income less than 250% of the FPL.  In this group, the high cost-sharing plan had a large effect on whether the parent decided to alter or delay their children’s treatment and ultimately whether or not they wound up getting care in the emergency room.

Cost sharing should not result in delaying necessary treatment for a manageable condition.  The intent should be to lower excess usage, and thus overall spending, of medical care.  However, for those with chronic conditions, higher cost sharing may only reduce spending in the short run.  Delaying necessary treatment for a manageable illness such as asthma can lead to future complications, ultimately raising overall cost and usage.  Similar to the ACA’s effort on preventive care, it’s reasonable to begin questioning whether reductions in cost sharing could be encouraged for chronic illnesses to ensure appropriate, effective care.

It is not altogether surprising that parents are changing and/or delaying treatment due to high cost sharing, however the difference with the families in Medicaid is striking.  Children who are in Medicaid and CHIP are less likely to experience a delay in their treatment due to cost sharing.  This should speak strongly to the important role CHIP and Medicaid serve in treating chronic illnesses, particularly as conversations on the future of CHIP and the comparability of marketplace coverage continue.

Keanan Lane is a research intern at Georgetown University’s Center for Children and Families and a McCourt School of Public Policy graduate student.