Effect of Cost Sharing on Screening Mammography

To the Editor: The study of cost sharing on mammography by Trivedi et al. (Jan. 26 issue) 1 and the editorial by Bach 2 may lead policymakers to favor value-based insurance over high-deductible health plans. Following the principles of value-based insurance to their logical end, Americans might consider health insurance that imposes no cost sharing whatsoever for cost-effective health care while excluding unproved technologies from coverage. Such insurance does exist — the National Health Service in the United Kingdom and Medicare in Canada are two examples. The hypothetical paradox described by Bach, in which a value-based insurance plan might encourage the use . . .