Effect of Shifting Costs to Patients on Specialty Evaluation for Sleep Disorders

Parambil, Joseph G.; Olson, Eric J.; Shepard Jr., John W.; Harris, Cameron D.; Schniepp, Brian J.; Schembari, Elaine E. G.; Morgenthaler, Timothy I.
February 2006
Mayo Clinic Proceedings;Feb2006, Vol. 81 Issue 2, p185
Academic Journal
OBJECTIVE: To determine whether the introduction of out-of-pocket expenses to medical center employees would lead to decreased use of sleep disorder services. PATIENTS AND METHODS: We retrospectively analyzed and compared the clinical and medical accounting data from visits by Mayo Clinic employees to the Sleep Disorders Center from January 1 to March 31, 2003, with that of January 1 to March 31, 2004, le, before and after a January 2004 increase in co-payments for evaluation and testing. RESULTS: The total number of new patients evaluated in the first quarters of 2003 and 2004 was similar (113 vs 119; P=.37). Snoring, restless legs symptoms, hypertension, atrial fibrillation, and prior overnight oximetry testing were more prevalent in 2004 than in 2003 (P=.05, P=-.01, P<.001, P=.003, P=.02, respectively). In contrast, insomnia and parasomnia complaints were less common in 2004 (P<.001). The mean apnea-hypopnea index, minimum oxygen saturation, and percentage of time with oxygen saturation less than 90% were all more severe In 2004 (P=.01, P=.001, P<.001, respectively). Sleep-related breathing disorders were more commonly diagnosed in 2004 (83.2% vs 67.2%; P=.02), whereas the diagnoses of nonbreathing disorders declined. CONCLUSION: The Insurance policy changes that resulted in larger empolyee co-payments shifted the spectrum of diagnoses seen at the Sleep Disorders Center toward more symptomatic patients, with more associated comorbidities, and patients who had more severe sleep-related breathing disorders. Total utilization did not decrease.


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