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Mitchell D. Wong, MD, PhD, Ronald Andersen, PhD, Cathy D. Sherbourne, PhD, Ron D. Hays, PhD and Martin F. Shapiro, MD, PhD

Mitchell D. Wong, Ron D. Hays, and Martin F. Shapiro are with the Division of General Internal Medicine and Health Services Research, University of California, Los Angeles. Ron D. Hays and Martin F. Shapiro are also with RAND, Santa Monica, Calif. Ronald Andersen is with the Department of Health Services, School of Public Health, University of California, Los Angeles. Cathy D. Sherbourne is with RAND, Santa Monica, Calif.

Correspondence: Requests for reprints should be sent to Mitchell D. Wong, MD, PhD, Division of General Internal Medicine and Health Services Research, 911 Broxton Plaza, Los Angeles, CA 90095-1736 (e-mail: miwong{at}mednet.ucla.edu).

Objectives. This study sought to determine the effect of cost sharing on medical care use for acute symptoms and on health status among chronically ill adults.

Methods. Data from the Medical Outcomes Study were used to compare (1) rates of physician care use for minor and serious symptoms and (2) 6- and 12-month follow-up physical and mental health status among individuals at different levels of cost sharing.

Results. In comparison with a no-copay group, the low- and high-copay groups were less likely to have sought care for minor symptoms, but only the high-copay group had a lower rate of seeking care for serious symptoms. Follow-up physical and mental health status scores were similar among the 3 copay groups.

Conclusions. In a chronically ill population, cost sharing reduced the use of care for both minor and serious symptoms. Although no differences in self-reported health status were observed, health plans featuring cost sharing need careful monitoring for potential adverse health effects because of their propensity to reduce use of care that is considered necessary and appropriate.

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