At a Glance | M a rch 4, 2 0 2 1 Does Health Care Coinsurance Reduce Use of Care More Than Copayments? MONTHLY SPENDING Average Out-of-Pocket Spending by Calendar Month Average out-of-pocket spending on inpatient care drops sharply $300 Inpatient Care after January, though spending $252 decreases in all categories. Because deductibles are often reached early in the year by high users of health care services, Prescription Drugs it can be argued that it is the $114 expected end-of-year out-of- Emergency Room $101 pocket costs that matter most Specialist Physicians when individuals are deciding $52 whether to use a health care Primary Care $20 $20 service even before they $0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec have reached their deductible. COINSURANCE VS. COPAYMENTS Change in Use of Health Care Services Due to a 1 Percent Increase in Cost Sharing Coinsurance reduces use of inpatient care and specialist Decrease Increase physician office visits more Coinsurance Copayment in Usage in Usage than copayments. In contrast, Statistically Significant % Change copayments reduce use of -0.18 Inpatient Care primary care office visits more - 0.0 5 than coinsurance. For inpatient 0.0 0 4 Emergency Room health care, each 1 percent 0.0 3 increase in coinsurance led to a 0.18 percent decrease -0.11 Primary Care in utilization. For specialty -0.19 physician office visits, each - 0.0 8 Specialist Physicians 1 percent increase in coinsurance - 0.0 3 led to a 0.19 percent decrease - 0. 23 in utilization. Physical Therapy - 0. 25 -0.16 Chiropractor Visits - 0. 3 3 -0.10 Psychotherapy/Counseling - 0.0 9 SOURCE: Paul Fronstin and M. Christopher Roebuck, “Managing Use of Health Care Services After People Satisfy Their Deductible: What Do Copayments and Coinsurance Do?,” EBRI Issue Brief, no. 519 (November 19, 2020). © 2021 EBRI This report is copyrighted by the Employee Benefit Research Institute (EBRI). You may copy, print, or download this report solely for personal and noncommercial use, provided that all hard copies retain any and all copyright and other applicable notices contained therein, and you may cite or quote small portions of the report provided that you do so verbatim and with proper citation. Any use beyond the scope of the foregoing requires EBRI’s prior express permission. For permissions, please contact EBRI at permissions@ebri.org.