OBJECTIVE To determine the impact of user fees on the utilization of health services in a community-based cost-sharing scheme in Kabarole District, western Uganda. METHODS Of the 38 government health units that had introduced user-fee financing schemes, 11 were included in the study. Outpatient utilization was assessed as the median number of visits per month before and after cost sharing beg...

INTRODUCTION The compulsory deductible, a form of patient cost-sharing in the Netherlands, has more than doubled during the past years. There are indications that as a result, refraining from medical care has increased. We studied the relation between patient cost-sharing and refraining from medical care by evaluating noncompliance with referrals to medical specialists over several years. MET...

Users share an increasing marginal cost technology. A method charges non negative cost shares covering costs. We look at the worst surplus (relative to the efficient surplus) in a Nash equilibrium of the demand game, where the minimum is taken over all convex preferences quasilinear in cost shares. We compare two budget-balanced methods, average cost pricing and serial cost sharing, and two met...

National-level data are limited regarding confidentiality-related issues and the use of sexually transmitted disease (STD) services for adolescents and young adults. Changes in the U.S. health care system have permitted dependent children to remain on a parent's health insurance plan until the child's 26th birthday and required coverage of certain preventive services, including some STD service...

Bayesian knowledge bases (BKBs) are a gen­ eralization of Bayes networks and weighted proof graphs (WAODAGs), that allow cycles in the causal graph. Reasoning in BKBs re­ quires finding the most probable inferences consistent with the evidence. The cost­ sharing heuristic for finding least-cost ex­ planations in WAODAGs was presented and shown to be effective by Charniak and Hu­ sain. However, ...

In cost sharing games with delays, a set of agents jointly allocates a finite subset of resources. Each resource has a fixed cost that has to be shared by the players, and each agent has a nonshareable player-specific delay for each resource. A prominent example is uncapacitated facility location (UFL), where facilities need to be opened (at a shareable cost) and clients want to connect to open...

The set of additive cost sharing methods when individual demands are integer valued and cost shares are non negative, is characterized by its extreme points and by a network flow representation. The extreme methods allocate costs incrementally along a chain of demand vectors independent of the cost function. The result generalizes Wang’s characterization in that we do not assume the Dummy axiom.

This article estimates the extent to which private insurance supplements affect use of services by Medicare enrollees. Three types of supplements to Medicare's coverage are examined--Health Maintenance Organizations (HMOs), medigap (MGP) plans, and employment-based indemnity (EBI) plans. While each kind of supplement reduces cost sharing on Medicare-covered services, only HMOs do so without inc...

We examine the efficiency-based arguments for second-best optimal health insurance with multiple treatment goods and multiple time periods. Correlated shocks across health care goods and over time interact with complementarity and substitutability to affect optimal cost sharing. Health care goods that are substitutes or have positively correlated demand shocks should have lower optimal patient ...

Cost-sharing rules for paying physicians have been advanced as a way of generating incentives for the provision of quality care, while recognizing their potential negative effects on production efficiency. However, the optimal sharing rate typically depends on the degree to which the physician acts in the interest of the patient, what we identify as the physician's altruism. Since the degree of...