Effect of shifting costs to patients on specialty evaluation for sleep disorders

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 analysed 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, ie, 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 employee 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.