Session (CTI)

ISSUE: ISPOR’s Strategic Plan 2030 identified affordability and its impact on the long-term sustainability of healthcare systems as a central challenge. Growing patient cost sharing, evolving health plan options, and complex benefit design underscore a need to improve our understanding of affordability from a patient’s perspective. There is limited information about domains of cost-related management strategies (CrMS) and their association with satisfaction and health status among Medicare beneficiaries. Relatedly, beneficiaries may experience substantial changes in their out-of-pocket cost burden and access to providers following selection into Medicare Advantage compared to Traditional Medicare. These perspectives on affordability have different policy implications. OVERVIEW: This session will address affordability, access, and policy through evaluations and critical discussions of data sources, measurement, and methodological implications on estimates of the effect of affordability on access. Specifically, the session will focus on the Medicare population in the US using two survey data sources – The Medicare Current Beneficiary Survey (MCBS) and Medical Expenditure Panel Survey (MEPS). Using the MCBS, the associations of the domains of CrMS with satisfaction and health status among beneficiaries will be quantified using fixed effects logistic regression. The effect of changes in out-of-pocket burdens and cost barriers associated with plan enrollment choices will be assessed using a fuzzy regression discontinuity design with MEPS data. Following each presentation, another panelist will critically discuss the assumptions, data, methods, and what it implies for their conclusions. Presenters will introduce the MCBS and MEPS studies (15 minutes each). Discussants will critique the studies with time for presenters to respond (10 minutes each). The session will conclude with audience Q&A (10 min). Session attendees, e.g., researchers, will gain a better understanding of the tradeoffs among frameworks, datasets, and modeling strategies needed to study patient affordability and generate policy-relevant findings.