Determinants of Change in Medicaid Pharmaceutical Cost Sharing: Does Evidence Affect Policy?
Open accessAbstract
Since 1980, many Medicaid programs have instituted, adjusted, or abolished pharmaceutical copayments or limitations on the number of prescriptions per patient (caps). Studies indicate that prescription caps can harm patients and increase Medicaid costs. However, because there is little information on how state policy makers select and evaluate such policies, in‐depth telephone interviews were conducted with key informants in Medicaid programs that had recently made changes in cost‐sharing policies. Among the barriers to evidence‐based policy making were lack of political power, skills, and infrastructure; crisis‐oriented decisions; compartmentalized budgeting; lack of advocates for disadvantaged patients; and the absence of timely research. Research was applied successfully when the interests of patient advocates and the drug industry were aligned and when Medicaid analysts were able to identify and communicate relevant research to policy makers at the time, or “teachable moment,” that policy was being changed.
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Decision makers, even if they have access to required information and have relevant expertise, may not engage in complex cognitive information processing when making decisions.
“However, decision-making research has shown that decision makers, even if they have access to required information and have relevant expertise, may not engage in complex cognitive information processing when making decisions [13,15,44,46-50].”
From Rationality versus reality: the challenges of evidence-based decision making for health policy makers (2010) · cites this paper as [15]
The Discussion (page unavailable) says Medicaid managers sometimes knew of relevant research and policy risks, yet political pressure for quick budget fixes often prevailed. This supports the point that access to information need not produce an evidence-based decision. The paper does not establish that decision makers with relevant expertise declined to engage in complex cognitive processing; it instead emphasizes political constraints and, in the ‘Lack of Infrastructure for Policy Formulation and Evaluation’ section, gaps in analytic skills. (LLM, conf=0.78)
Experimental — accuracy not yet measuredCognitive processing research has identified both bounded rationality and 'satisficing' as limitations to complex cognitive processing.
“For example, cognitive processing research has identified both bounded rationality and 'satisficing' as limitations to complex cognitive processing [2,15,44,46-50].”
From Rationality versus reality: the challenges of evidence-based decision making for health policy makers (2010) · cites this paper as [15]
The 'Lack of Infrastructure for Policy Formulation and Evaluation' section (page unavailable) describes limited analytic skills and subjective Medicaid policy decisions, but does not identify bounded rationality or satisficing as cognitive-processing limitations. Searches for both terms found no passage in our copy addressing that claim. (LLM, conf=0.76)
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Research works printed but not linked: 14
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How Can Research Organizations More Effectively Transfer Research Knowledge to Decision Makers?
LAVIS, J. N., ROBERTSON, D., WOODSIDE, J. M., McLEOD, C. B., & ABELSON, J. (2003) · The Milbank Quarterly · doi:10.1111/1468-0009.t01-1-00052 · Cited by 1,176 · see citing works
McCaughey, D., & Bruning, N. S. (2010) · Implementation Science · doi:10.1186/1748-5908-5-39 · Cited by 160 · see citing works
- Authors
- Soumerai, S. B., Ross‐Degnan, D., Fortess, E. E., & Walser, B. L.
- Affiliations
- Harvard University (US)
- Harvard Pilgrim Health Care (US)
- Venue
- The Milbank Quarterly
- Publisher
- Wiley
- Published
- 1997-03
- Volume
- 75
- Issue
- 1
- Pages
- 11-34
- ISSN
- 0887-378X (ISSN-L)
- 1468-0009
- PMC
- PMC2751039
- OpenAlex
- W2084029131
- Cited by
- 23
- References
- 0
- Citations by year
- 2016: 2 · 2013: 1
- FWCI
- 5.32
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Milbank Quarterly (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Robert Wood Johnson Foundation
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Pharmaceutical Economics and Policy
- Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
- Keywords
- Medicaid, evidence-based policy making, health policy decision-making, patient advocates, pharmaceutical industry influence, teachable moments, Medicaid costs
- MeSH terms
- Deductibles and Coinsurance, Health Policy, Health Services Research, Humans, Insurance, Pharmaceutical Services, Interviews as Topic, Medicaid, Patient Advocacy, Politics, Drug Prescriptions, United States, Cost Sharing
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