Remler Dahlia K, Greene Jessica
School of Public Affairs, Baruch College, City University of New York, New York, NY, 10010, USA.
Annu Rev Public Health. 2009;30:293-311. doi: 10.1146/annurev.publhealth.29.020907.090804.
Cost-sharing is a health care cost-containment technique in which health care services are partially paid for by patients out of pocket. Cost-sharing can reduce non-cost-effective care, but it can also undermine the financial protection and access values of health insurance. We review the empirical evidence published since the mid-1980s about cost-sharing's effect on utilization, expenditures, health, and adverse consequences, including how the effects vary by form of care, by health status, and by sociodemographic characteristics. Some cost-sharing, such as emergency department copayments, reduces utilization without any harmful effects, whereas other cost-sharing reduces valuable care such as maintenance drug use among the chronically ill. Cost-sharing should be used judiciously, with attention taken not to reduce highly cost-effective care.
费用分担是一种医疗成本控制技术，即患者需自掏腰包支付部分医疗服务费用。费用分担可以减少非成本效益高的医疗服务，但也可能损害医疗保险的财务保护和可及性价值。我们回顾了自20世纪80年代中期以来发表的关于费用分担对医疗服务利用、支出、健康及不良后果影响的实证证据，包括这些影响如何因医疗形式、健康状况和社会人口特征的不同而有所差异。一些费用分担，如急诊科的自付费用，可减少医疗服务利用且无任何有害影响，而其他费用分担则会减少诸如慢性病患者维持用药等有价值的医疗服务。应谨慎使用费用分担，注意不要减少成本效益高的医疗服务。
