Is Patient Cost-Sharing the Best Way to Protect the Medical Commons?
Authors: Anish P. Mahajan, Robert H. Brook
Journal: Annals of Internal Medicine (2008)

Letters16 September 2008Is Patient Cost-Sharing the Best Way to Protect the Medical Commons?Anish P. Mahajan, MD, MPH and Robert H. Brook, MD, ScDAnish P. Mahajan, MD, MPHFrom David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90024, and The RAND Corporation, Santa Monica, CA 90407.Search for more papers by this author and Robert H. Brook, MD, ScDFrom David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90024, and The RAND Corporation, Santa Monica, CA 90407.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-149-6-200809160-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We thank Dr. Fletcher and colleagues for their thoughtful letter describing HPHC's decision-making process and rationale for providing first-dollar coverage of FOBT, but not colonoscopy, in its high-deductible health plan. The HPHC's ethics advisory group, which engages a range of stakeholders, is laudable.Dr. Fletcher and colleagues defend HPHC's decision to provide first-dollar coverage for FOBT but not colonoscopy by citing evidence-based guidelines, from the time when the coverage decision was made, that regarded the 2 screening interventions as equally effective. In light of new consensus guidelines recommending colonoscopy over FOBT because of the added benefit of early ...References1. Levin B, Lieberman DA, McFarland B, Smith RA, Brooks D, Andrews KS, et al; American Cancer Society Colorectal Cancer Advisory Group. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008;58:130-60. [PMID: 18322143] CrossrefMedlineGoogle Scholar2. Harvard Pilgrim Health Care. Six Facts About the HPHC Insurance Company Best Buy HSA PPO—Massachusetts. Accessed at https://www.harvardpilgrim.org/pls/portal/docs/PAGE/MEMBERS/COVERAGE/BESTBUYHSAPPO/CC2389_MA_PRE.PDF on 5 August 2008. Google Scholar3. Goldman DP, Joyce GF, Escarce JJ, Pace JE, Solomon MD, Laouri M, et al. Pharmacy benefits and the use of drugs by the chronically ill. JAMA. 2004;291:2344-50. [PMID: 15150206] CrossrefMedlineGoogle Scholar4. Newhouse JP; The Insurance Experiment Group. Free for All? Lessons from the RAND Health Insurance Experiment. Cambridge, MA: Harvard Univ Pr; 1993. Google Scholar5. Schuster MA, McGlynn EA, Brook RH. How good is the quality of health care in the United States? 1998. Milbank Q. 2005;83:843-95. [PMID: 16279970] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90024, and The RAND Corporation, Santa Monica, CA 90407.Disclaimer: Dr. Brook's wife, Dr. Jacqueline Kosecoff, is CEO of Prescription Solutions.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCancer Screening before and after Switching to a High-Deductible Health Plan J. Frank Wharam , Alison A. Galbraith , Ken P. Kleinman , Stephen B. Soumerai , Dennis Ross-Degnan , and Bruce E. Landon High-Deductible Health Plans and Better Benefit Design Anish P. Mahajan and Robert H. Brook Is Patient Cost-Sharing the Best Way to Protect the Medical Commons? Robert H. Fletcher , James E. Sabin , and Joseph Dorsey Metrics 16 September 2008Volume 149, Issue 6Page: 435-436KeywordsAsthmaColonoscopyConflicts of interestHealth careHealth information technologyHypertension ePublished: 16 September 2008 Issue Published: 16 September 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...