Dr Mark Fendrick on the Importance of Low, No Cost Sharing in HIV Care, Other Public Health Issues

A. Mark Fendrick, MD, professor of Medicine in the School of Medicine, professor of Health Management and Policy in the School of Public Health, and director of the VBID Center at the University of Michigan, discusses how low or no cost sharing for high-value services is particularly important for public health issues or epidemics, such as HIV.

How is low/no cost sharing for high-value services particularly important for public health issues or epidemics, such as HIV, where there is often access issues for those affected?

My mother always said, “I can’t believe you had to spend $1 million to show that if you make people pay more for something they’ll buy less of it,” and as we move through value-based insurance design, now almost on 20 years, we’ve also shown that if we reduce barriers—financial and otherwise—to high-value care, people will use more of these services more often. It’s important to note that when you make something free, it doesn’t mean that 100% of the people who should be getting the care, whether it be HIV testing or PrEP [pre-exposure prophylaxis] or mammograms or hepatitis C screening, to 100%.

We do know that as we’ve studied the evaluations of decreased cost sharing for high-value services, the rates of these services go up. But, they go up in a modest way. They don’t get anywhere near where I’d hope, meaning that we need not only cost-sharing reform but healthcare literacy issues, access, and many other levers we think we should pull to ultimately spend more money to get more folks the services we know will make them healthier. And the way we figured out to pay for these efforts is to attack the estimated $1 trillion in healthcare spending in the US that doesn’t make Americans any healthier.

It’s very fortunate for me and maybe unfortunate for the payers that there is such an excess of low-value care in this country. And luckily enough for us, everyone agrees there’s enough money in the system, we just spend it in the wrong places, and hopefully we’ll spend more on preventive care services like those covered by Section 2713 and HIV screening and PrEP, specifically, and less hopefully on those low-value services that have been identified by the task force as D rated or those identified by the Choosing Wisely Campaign.