Cost Sharing Among Persons with MS (P4.147)

OBJECTIVE To assess the impact of cost-sharing on healthcare utilization among persons with multiple sclerosis (MS). BACKGROUND Prior studies suggest that out-of-pocket health care costs are increasing. Although high out-of-pocket costs are undesirable, low out-of-pocket costs may indicate a desirable situation (excellent health insurance) or undesirable situation (deferral of needed health care). An alternate method for analyzing out-of-pocket costs is through cost sharing, a ratio of out-of-pocket costs to total health care costs. DESIGN/METHODS We analyzed the 1996-2009 Medical Expenditure Panel Survey (MEPS), an annual survey of representative households in the United States. MEPS participants are followed for two years. Out-of-pocket and total costs were expressed in 2013 dollars, adjusting for medical inflation. We constructed models using number of office visits or prescription medications as the dependent variable. The variables of interest were cost-sharing in the prior year, MS, and an interaction term of cost-sharing and MS. The models controlled for age, sex, race, education, insurance, income, perceived health status, and comorbidities. RESULTS There were 146,278 persons without MS and 277 with MS. Expressed in 2013 dollars, the mean out-of-pocket costs were $912 for persons without MS and $3287 for persons with MS. For persons without MS, the cost-sharing ratio was 27% for office visits and 51% for prescription drugs. For persons with MS, the cost-sharing ratio was 19% for office visits, and 38% for prescription drugs. A higher cost-sharing ratio was associated with fewer office visits (p<0.001) and unique medications (p<0.001) in the subsequent year. Cost-sharing among persons with MS had a differentially greater impact (p<0.001) on the number of unique prescription medications among persons without MS. CONCLUSIONS Compared to persons without MS, persons with MS had substantially higher out-of-pocket costs, even though insurers covered a higher proportion of health costs. Given that cost-sharing affects future utilization, we will further explore whether cost-sharing also has an impact on quality of care. Study Supported by: The National Multiple Sclerosis Society Disclosure: Dr. Cheng has nothing to disclose. Dr. Dora has nothing to disclose. Dr. Ayad has nothing to disclose. Dr. Chen has nothing to disclose. Dr. Langer-Gould has received research support from Biogen Idec and Roche. Dr. Ettner has nothing to disclose.