Patients' Reported Preferences for Episode-Based Cost-Sharing Models: A Survey Study.

Abstract

Purpose: Episode-based cost-sharing (EBCS), defined as prospectively set patients' cost-sharing obligations for an entire episode of care, is proposed to reduce cost uncertainty for patients. We aimed to assess patient preferences for EBCS for three hypothetical care episodes: breast cancer screening (BCS), lung cancer screening (LCS) and childbirth.

Methods: Adult, English-speaking Amazon Mechanical Turk workers participated in three surveys, with eligibility varying based on the screening eligibility criteria for BCS, LCS, and the ability to give birth. Using a choice-based experiment, participants stated their preferred cost-sharing model for BCS, LCS, and childbirth. Selections were from nine models constructed based on two attributes each with 3 levels: (1) initial cost (no/low, intermediate, high), and (2) subsequently revealed additional cost if other/different medical services were needed (no, intermediate, uncertain). Data were analyzed using Hierarchical Bayesian conjoint analysis to compare preferences for EBCS (high or intermediate initial cost, no subsequent cost for additional services) vs. the status quo (no/low initial cost with uncertain cost of additional services).

Results: A total of 103, 103, and 102 individuals participated in the BCS, LCS, and childbirth surveys. Across all three surveys, EBCS models were preferred over the status quo by 18.1 percentage points (pp) (95% CI 17.8, 18.4) for BCS, 12.0 pp (95% CI 11.7, 12.3) for LCS, and 44.5 pp (95% CI 44.1, 44.9) for childbirth. Cost-sharing models with uncertain additional costs were the least preferred across all surveys.

Conclusions: Health care consumers prefer cost-sharing models that prospectively guarantee out-of-pocket costs for entire care episodes.