A Comparison of the Utilization of Health Services in the Presence or Absence of Prescriptive Drug Insurance in a Managed Care Environment

This study tested if the availability of third party payment for prescriptive drugs as part of employer sponsored health insurance was associated with a change in the utilization of four types of health services in an independent practice association (IPA). The study employed the individual determinants component of the Andersen-Newman theoretical framework for health services utilization. Groups of employees in companies that offered health insurance identical in all ways except for the presence or absence of the prescriptive rider were included in the study which resulted in a population of 122 companies (89 with prescriptive rider insurance and 33 without prescriptive rider insurance) involving 931 members. Two years of claims data were analyzed to identify differences in utilization of primary care providers, urgent care centers, emergency departments and hospitals. Using measures of central tendency to evaluate expenditures, utilization of the relatively lower-cost health services such as visits to the primary care provider and urgent care centers was greater in the group of companies offering the rider benefit than the group of companies that did not include prescriptive drugs as part of the health care benefit. The two groups experienced similar utilization of emergency departments. The average expenditure per company for hospital utilization was 67.8% lower in the group with prescriptive insurance as compared to the group without prescriptive insurance. Taken together, average expenditures per company for the four health services totaled $1573 more for the group without prescriptive insurance as compared to the group with prescriptive insurance. The results of this study suggest that the patient with financial barriers to prescriptive medication may not be utilizing office visits to the primary care provider or urgent care center and raises a question regarding the more costly hospital services that may result