Methods: We searched PUBMED, MEDLINE, and EMBASE databases for studies published in the US from 2000-2014 that included the keywords: (‘immunizations’ or ‘vaccine’ or ‘vaccinations’ or ‘screenings’ or preventive service’ or ‘preventive measure’) and (‘cost sharing’ or ‘copayment’ or ‘copay’ or ‘out-of-pocket’). We extracted information on study results and grouped services by type (i.e. immunization or screenings/counseling/other services).
Results: We identified 23 studies: 7 examined immunizations and 16 examined screenings/counseling/other services. All studies reported an inverse relationship between cost-sharing and the use of preventive services. Some vaccines are covered under high-tiered pharmacy benefit plans, especially in Medicare Part D, and require high out-of-pocket expenses. Disproportionate cost sharing reportedly had a negative effect on the use of mammography and colorectal screenings. Some studies reported patients not receiving vaccines due to cost and reimbursement issues at the provider level (e.g. physicians not stocking the vaccine and thus decreasing availability). Several interventions have reduced cost-sharing and have shown to be effective in increasing the uptake of preventive services. While the Affordable Care Act (ACA) may omit cost-sharing for preventive services, there may be a percentage of individuals who still pay out-of-pocket costs or who accrue costs due to use of preventive service (e.g. follow-up treatment.)
Conclusion: This review suggests cost-sharing is a critical factor in the uptake of preventive health services and contributes in part to the forgoing of preventive services in the US. While some studies that have shown reducing cost sharing for vaccinations for children and adolescents has increased immunizations, this has not been shown among adults. Additional studies that examine this association, particularly post ACA, are needed.
Merck Co. & Inc.:
D. Zhang, Merck Co. & Inc.: Employee , Salary
K. Kawai, Merck & Co., Inc.: Consultant , Consulting fee
C. Acosta, Merck & Co., Inc: Employee , Salary
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