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Berger M, Six E, Czypionka T. Policy implications of heterogeneous demand reactions to changes in cost-sharing: Patient-level evidence from Austria. Soc Sci Med 2024; 340:116488. [PMID: 38101171 DOI: 10.1016/j.socscimed.2023.116488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/11/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023]
Abstract
Cost-sharing is a prominent tool in many healthcare systems, both for raising revenue and steering patient behaviour. Although the effect of cost-sharing on demand for healthcare services has been heavily studied in the literature, researchers often apply a macro-perspective to these issues, opening the door for policy makers to the fallacy of assuming uniform demand reactions across a spectrum of different forms of treatments and diagnostic procedures. We use a simple classification system to categorize 11 such healthcare services along the dimensions of urgency and price to estimate patients' (anticipatory) demand reactions to a reduction in the co-insurance rate by a sickness fund in the Austrian social health insurance system. We use a two-stage study design combining matching and two-way fixed effects difference-in-differences estimation. Our results highlight how an overall joint estimate of an average increase in healthcare service utilization (0.8%) across all healthcare services can be driven by healthcare services that are deferrable (+1%), comparatively costly (+1.4%) or both (+1.6%) and for which patients also postponed their consumption until after the cost-sharing reduction. In contrast, we do not find a clear demand reaction for inexpensive or urgent services. The detailed analysis of the demand reaction for each individual healthcare service further illustrates their heterogeneity. We show that even comparatively minor changes to the costs borne by patients may already evoke tangible (anticipatory) demand reactions. Our findings help policy makers better understand the implications of heterogeneous demand reactions across healthcare services for using cost-sharing as a policy tool.
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Affiliation(s)
- Michael Berger
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria; Institute for Advanced Studies, Josefstädterstraße 39, 1080, Vienna, Austria.
| | - Eva Six
- Research Institute Economics of Inequality, Vienna University of Economics and Business, Welthandelsplatz 1, 1020, Wien, Austria
| | - Thomas Czypionka
- Institute for Advanced Studies, Josefstädterstraße 39, 1080, Vienna, Austria; London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
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2
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Zimmermann S. Learning from the German experience of user fees. BMJ 2023; 380:603. [PMID: 36940977 DOI: 10.1136/bmj.p603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
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Wang J, Song Z, Zhang Y, Hussain RY. Can low-carbon pilot policies improve the efficiency of urban carbon emissions?--A quasi-natural experiment based on 282 prefecture-level cities across China. PLoS One 2023; 18:e0282109. [PMID: 36827253 PMCID: PMC9955968 DOI: 10.1371/journal.pone.0282109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023] Open
Abstract
Low-carbon pilot policies are an important way to achieve the goal of "peak carbon neutrality" and are of great significance to China's international commitments. Based on a sample of 282 prefecture-level cities from 2006 to 2020, this paper investigates the impact of low-carbon pilot policies on urban carbon efficiency using a quasi-natural experiment with three batches of low-carbon pilot cities in 2010, 2012, and 2017, respectively. It is found that: (1) low-carbon pilot cities can improve urban carbon emission efficiency, which is still valid after a series of robustness tests such as the parallel trend test, placebo test, PSM-DID, and counterfactual test; (2) low-carbon pilot cities can enhance urban carbon emission efficiency by promoting the level of urban innovation and advanced urban industrial structure; and (3) the impact of low-carbon pilot policies on urban carbon emission efficiency is heterogeneous across cities with different geographical locations, population sizes, and resource endowment types. The findings provide policy insights for the promotion of low-carbon pilot policies and strengthening the construction of low-carbon pilot cities.
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Affiliation(s)
- Jian Wang
- School of Finance and Economics, Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China
| | - Zhihui Song
- School of Finance and Economics, Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China
| | - Yuzhen Zhang
- School of Finance and Economics, Jiangsu University, Zhenjiang, Jiangsu, People’s Republic of China
| | - Rana Yassir Hussain
- Division of Management and Administrative Sciences, UE Business School, University of Education Lahore, Pakistan
- * E-mail:
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Xu M, Bittschi B. Does the abolition of copayment increase ambulatory care utilization?: a quasi-experimental study in Germany. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:1319-1328. [PMID: 35084631 DOI: 10.1007/s10198-022-01430-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 01/06/2022] [Indexed: 06/14/2023]
Abstract
Due to a problematic situation with public finances, Germany introduced a copayment scheme for ambulatory care visits in 2004. In 2012, Germany achieved a balanced budget, and copayment was abolished on the 1st of January 2013. This policy change offers a rare opportunity to explore the impact of the abolition of copayment, compared to the much more frequently studied introduction of copayment. We therefore investigate the development of ambulatory care and inpatient care utilization following this policy change among people over 50 in Germany, as well as the heterogeneous impacts among vulnerable people, such as the low-income population, the chronically ill and the elderly over the age of 65. We use data from the Survey of Health, Ageing and Retirement in Europe and adopt a difference-in-differences approach with matching. We found that the abolition of copayment only caused an increase in ambulatory care use in the shorter term, while leading to a significant reduction in the longer term. In addition, we find a negative effect on inpatient care use, i.e., the hospitalization offset effect. Finally, we demonstrate that vulnerable people were more sensitive to the abolition of copayment.
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Affiliation(s)
- Mingming Xu
- School of Public Health (Shenzhen), Sun Yat-sen University, Gongchang Road 66, Shenzhen, 518107, China.
- Department of Economics and Management, Karlsruhe Institute of Technology, Kronenstraβe 34, 76133, Karlsruhe, Germany.
| | - Benjamin Bittschi
- Austrian Institute of Economic Research (WIFO), Arsenal, Objekt 20, 1030, Vienna, Austria
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Koohi Rostamkalaee Z, Jafari M, Gorji HA. A systematic review of strategies used for controlling consumer moral hazard in health systems. BMC Health Serv Res 2022; 22:1260. [PMID: 36258192 PMCID: PMC9580205 DOI: 10.1186/s12913-022-08613-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Consumer moral hazard refers to an increase in demand for health services or a decrease in preventive care due to insurance coverage. This phenomenon as one of the most evident forms of moral hazard must be reduced and prevented because of its important role in increasing health costs. This study aimed to determine and analyze the strategies used to control consumer moral hazards in health systems. Methods In this systematic review. Web of Sciences, PubMed, Scopus, Embase, ProQuest, Iranian databases(Magiran and SID), and Google Scholar engine were searched using search terms related to moral hazard and healthcare utilization without time limitation. Eligible English and Persian studies on consumer moral hazard in health were included, and papers outside the health and in other languages were excluded. Thematic content analysis was used for data analysis. Results Content analysis of 68 studies included in the study was presented in the form of two group, six themes, and 11 categories. Two group included “changing behavior at the time of receiving health services” and “changing behavior before needing health services.” The first group included four themes: demand-side cost sharing, health savings accounts, drug price regulation, and rationing of health services. The second approach consisted of two themes Development of incentive insurance programs and community empowerment. Conclusion Strategies to control consumer moral hazards focus on changing consumer consumptive and health-related behaviors, which are designed according to the structure of health and financing systems. Since “changing consumptive behavior” strategies are the most commonly used strategies; therefore, it is necessary to strengthen strategies to control health-related behaviors and develop new strategies in future studies. In addition, in the application of existing strategies, the adaptation to the structure of the health and financing system, and the pattern of consumption of health services in society should be considered. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08613-y.
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Affiliation(s)
- Zohreh Koohi Rostamkalaee
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Jafari
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
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Olm M, Donnachie E, Tauscher M, Gerlach R, Linde K, Maier W, Schwettmann L, Schneider A. Ambulatory specialist costs and morbidity of coordinated and uncoordinated patients before and after abolition of copayment: A cohort analysis. PLoS One 2021; 16:e0253919. [PMID: 34181693 PMCID: PMC8238183 DOI: 10.1371/journal.pone.0253919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022] Open
Abstract
To strengthen the coordinating function of general practitioners (GPs) in the German healthcare system, a copayment of €10 was introduced in 2004. Due to a perceived lack of efficacy and a high administrative burden, it was abolished in 2012. The present cohort study investigates characteristics and differences of GP-coordinated and uncoordinated patients in Bavaria, Germany, concerning morbidity and ambulatory specialist costs and whether these differences have changed after the abolition of the copayment. We performed a retrospective routine data analysis, using claims data of the Bavarian Association of the Statutory Health Insurance Physicians during the period 2011–2012 (with copayment) and 2013–2016 (without copayment), covering 24 quarters. Coordinated care was defined as specialist contact only with referral. Multinomial regression modelling, including inverse probability of treatment weighting, was used for the cohort analysis of 500 000 randomly selected patients. Longitudinal regression models were calculated for cost estimation. Coordination of care decreased substantially after the abolition of the copayment, accompanied by increasing proportions of patients with chronic and mental diseases in the uncoordinated group, and a corresponding decrease in the coordinated group. In the presence of the copayment, uncoordinated patients had €21.78 higher specialist costs than coordinated patients, increasing to €24.94 after its abolition. The results indicate that patients incur higher healthcare costs for specialist ambulatory care when their care is uncoordinated. This effect slightly increased after abolition of the copayment. Beyond that, the abolition of the copayment led to a substantial reduction in primary care coordination, particularly affecting vulnerable patients. Therefore, coordination of care in the ambulatory setting should be strengthened.
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Affiliation(s)
- Michaela Olm
- TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Munich, Bavaria, Germany
- * E-mail:
| | - Ewan Donnachie
- Bavarian Association of Statutory Health Insurance Physicians, Munich, Bavaria, Germany
| | - Martin Tauscher
- Bavarian Association of Statutory Health Insurance Physicians, Munich, Bavaria, Germany
| | - Roman Gerlach
- Bavarian Association of Statutory Health Insurance Physicians, Munich, Bavaria, Germany
| | - Klaus Linde
- TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Munich, Bavaria, Germany
| | - Werner Maier
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Bavaria, Germany
| | - Lars Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Bavaria, Germany
- Department of Economics, Martin Luther University Halle-Wittenberg, Halle an der Saale, Saxony-Anhalt, Germany
| | - Antonius Schneider
- TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Munich, Bavaria, Germany
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Olm M, Donnachie E, Tauscher M, Gerlach R, Linde K, Maier W, Schwettmann L, Schneider A. Impact of the abolition of copayments on the GP-centred coordination of care in Bavaria, Germany: analysis of routinely collected claims data. BMJ Open 2020; 10:e035575. [PMID: 32878752 PMCID: PMC7470646 DOI: 10.1136/bmjopen-2019-035575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES In 2012, Germany abolished copayment for consultations in ambulatory care. This study investigated the effect of the abolition on general practitioner (GP)-centred coordination of care. We assessed how the proportion of patients with coordinated specialist care changed over time when copayment to all specialist services were removed. Furthermore, we studied how the number of ambulatory emergency cases and apparent 'doctor shopping' changed after the abolition. DESIGN A retrospective routine data analysis of the Bavarian Association of Statutory Health Insurance Physicians, comparing the years 2011 and 2012 (with copayment), with the period from 2013 to 2016 (without copayment). Therefore, time series analyses covering 24 quarters were performed. SETTING Primary care in Bavaria, Germany. PARTICIPANTS All statutorily insured patients in Bavaria, aged ≥18 years, with at least one ambulatory specialist contact between 2011 and 2016. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was the percentage of patients with GP-coordinated care (every regular specialist consultation within a quarter was preceded by a GP referral). Secondary outcomes were the number of ambulatory emergency cases and apparent 'doctor shopping'. RESULTS After the abolition, the proportion of coordinated patients decreased from 49.6% (2011) to 15.5% (2016). Overall, younger patients and those living in areas with lower levels of deprivation showed the lowest proportions of coordination, which further decreased after abolition. Additionally, there were concomitant increases in the number of ambulatory emergency contacts and to a lesser extent in the number of patients with apparent 'doctor shopping'. CONCLUSIONS The abolition of copayment in Germany was associated with a substantial decrease in GP coordination of specialist care. This suggests that the copayment was a partly effective tool to support coordinated care. Future studies are required to investigate how the gatekeeping function of GPs in Germany can best be strengthened while minimising the associated administrative overhead.
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Affiliation(s)
- Michaela Olm
- Institute of General Practice and Health Services Research, Technical University of Munich, TUM School of Medicine, Munich, Germany
| | - Ewan Donnachie
- Bavarian Association of Statutory Health Insurance Physicians, Munich, Germany
| | - Martin Tauscher
- Bavarian Association of Statutory Health Insurance Physicians, Munich, Germany
| | - Roman Gerlach
- Bavarian Association of Statutory Health Insurance Physicians, Munich, Germany
| | - Klaus Linde
- Institute of General Practice and Health Services Research, Technical University of Munich, TUM School of Medicine, Munich, Germany
| | - Werner Maier
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Lars Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Department of Economics, Martin Luther University Halle-Wittenberg, Halle an der Saale, Germany
| | - Antonius Schneider
- Institute of General Practice and Health Services Research, Technical University of Munich, TUM School of Medicine, Munich, Germany
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Can telehealth reduce health care expenditure? A lesson from German health insurance data. Int J Health Plann Manage 2019; 34:1121-1132. [DOI: 10.1002/hpm.2764] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 11/07/2022] Open
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Herrmann WJ, Haarmann A, Bærheim A. Patients' attitudes toward copayments as a steering tool-results from a qualitative study in Norway and Germany. Fam Pract 2018; 35:312-317. [PMID: 28973219 DOI: 10.1093/fampra/cmx092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Copayments are implemented in many health care systems. The effect of copayments differs between countries. Up to now, patients' attitudes regarding copayments are mainly unknown. OBJECTIVES Thus, the goal of our analysis was to explore adult patients' attitudes in Germany and Norway towards copayments as a steering tool. METHODS We conducted a qualitative comparative study. Episodic interviews were conducted with 40 patients in Germany and Norway. The interviews were analysed by thematic coding in the framework of grounded theory. All text segments related to copayments were analysed in depth for emerging topics and types. RESULTS We found three dimensions of patients' attitudes towards copayments: the perceived steering effect, the comprehensibility, and the assessment of copayments. The perceived steering effect consists of three types: having been influenced by copayments, not having experienced any influence and the experience of other persons to be influenced. The category comprehensibility describes that not all patients understand rules and regulations of copayments and its caps. The assessment of copayments consists of nine subcategories, three of which are rather negative and six of which are rather positive. In all three dimensions the patterns between the German and Norwegian sub-samples differ considerably. CONCLUSIONS The results of our study point at the importance of communicating clear rules for copayments which are easily comprehensible.
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Affiliation(s)
- Wolfram J Herrmann
- Institute of General Practice, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Institute of General Practice and Family Medicine, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
| | - Alexander Haarmann
- Institute of General Practice and Family Medicine, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany.,Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
| | - Anders Bærheim
- Institute of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Farbmacher H, Ihle P, Schubert I, Winter J, Wuppermann A. Heterogeneous Effects of a Nonlinear Price Schedule for Outpatient Care. HEALTH ECONOMICS 2017; 26:1234-1248. [PMID: 27492210 DOI: 10.1002/hec.3395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 06/08/2016] [Accepted: 07/11/2016] [Indexed: 06/06/2023]
Abstract
Nonlinear price schedules generally have heterogeneous effects on health-care demand. We develop and apply a finite mixture bivariate probit model to analyze whether there are heterogeneous reactions to the introduction of a nonlinear price schedule in the German statutory health insurance system. In administrative insurance claims data from the largest German health insurance plan, we find that some individuals strongly react to the new price schedule while a second group of individuals does not react. Post-estimation analyses reveal that the group of the individuals who do not react to the reform includes the relatively sick. These results are in line with forward-looking behavior: Individuals who are already sick expect that they will hit the kink in the price schedule and thus are less sensitive to the co-payment. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Helmut Farbmacher
- Munich Center for the Economics of Aging (MEA), Max Planck Society, Munich, Germany
| | - Peter Ihle
- PMV forschungsgruppe at the Department of Child and Adolescents Psychiatry, University of Cologne, Cologne, Germany
| | - Ingrid Schubert
- PMV forschungsgruppe at the Department of Child and Adolescents Psychiatry, University of Cologne, Cologne, Germany
| | - Joachim Winter
- Department of Economics, University of Munich, Munich, Germany
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Kronborg C, Pedersen LB, Fournaise A, Kronborg CN. User Fees in General Practice: Willingness to Pay and Potential Substitution Patterns-Results from a Danish GP Patient Survey. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:615-624. [PMID: 28364368 DOI: 10.1007/s40258-017-0325-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Increases in public expenditures to general practitioner (GP) services and specialist care have spurred debate over whether to implement user fees for healthcare services such as GP consultations in Denmark. OBJECTIVE The objective of this study was to examine Danish patients' attitudes towards user fees and their willingness to pay (WTP) for a consultation, and to investigate how user charges may impact patients' behaviour. METHODS A questionnaire survey was conducted in a GP clinic. RESULTS A total of 343 individual persons answered the questionnaire. One hundred and seventy (50%) persons were not willing to pay for a consultation. Among patients reporting positive WTP values, the mean WTP was 137 (standard deviation 140) Danish kroner (DKK). Patients who were 65 years old or older were more likely to be willing to pay for a GP consultation than patients under the age of 65 years. Furthermore, patients with a personal annual income of more than 200,000 DKK were more likely to be willing to pay for a consultation than other income groups. With respect to patients with a positive WTP value, their own assessment of the seriousness of the consultation and their self-assessed health influenced the amount they would be willing to pay. Finally, we observed a stated willingness to substitute GP consultations with alternatives that are free of charge. CONCLUSION About half of the patients with an appointment for a GP consultation are willing to pay for the consultation. User charges may potentially influence the patients' behaviour. ClinicalTrials.gov NCT01784731.
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Affiliation(s)
- Christian Kronborg
- Department of Business and Economics, University of Southern Denmark, Centre of Health Economics Research (COHERE), Campusvej 55, 5230, Odense M, Denmark.
| | - Line Bjørnskov Pedersen
- Department of Business and Economics, University of Southern Denmark, Centre of Health Economics Research (COHERE), Campusvej 55, 5230, Odense M, Denmark
- Research Unit for General Practice, University of Southern Denmark, J.B. Winsløws Vej 9B, 5000, Odense C, Denmark
| | - Anders Fournaise
- Department of Cross-sectorial Collaboration, Region of Southern Denmark, Damhaven 12, 7100, Vejle, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark
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Kunz JS, Winkelmann R. An Econometric Model of Healthcare Demand With Nonlinear Pricing. HEALTH ECONOMICS 2017; 26:691-702. [PMID: 27045384 DOI: 10.1002/hec.3343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 12/11/2015] [Accepted: 02/29/2016] [Indexed: 06/05/2023]
Abstract
From 2004 to 2012, the German social health insurance levied a co-payment for the first doctor visit in a calendar quarter. We develop a new model for estimating the effect of such a co-payment on the individual number of visits per quarter. The model combines a one-time increase in the otherwise constant hazard rate determining the timing of doctor visits with a difference-in-differences strategy to identify the reform effect. An extended version of the model accounts for a mismatch between reporting period and calendar quarter. Using data from the German Socio-Economic Panel, we do not find an effect of the co-payment on demand for doctor visits. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Johannes S Kunz
- Department of Economics, University of Zurich, Zurich, Switzerland
| | - Rainer Winkelmann
- Department of Economics, University of Zurich, Zurich, Switzerland
- IZA, Bonn, Germany
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13
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Lee HJ, Jang SI, Park EC. The effect of increasing the coinsurance rate on outpatient utilization of healthcare services in South Korea. BMC Health Serv Res 2017; 17:152. [PMID: 28219377 PMCID: PMC5319163 DOI: 10.1186/s12913-017-2076-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 02/07/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The Korean healthcare system is composed of costly and inefficient structures that fail to adequately divide the functions and roles of medical care organizations. To resolve this matter, the government reformed the cost-sharing policy in November of 2011 for the management of outpatients visiting general or tertiary hospitals with comparatively mild diseases. The purpose of the present study was to examine the impact of increasing the coinsurance rate of prescription drug costs for 52 mild diseases at general or tertiary hospitals on outpatient healthcare service utilization. METHODS The present study used health insurance claim data collected from 2010 to 2013. The study population consisted of 505,691 outpatients and was defined as those aged 20-64 years who had visited medical care organizations for the treatment of 52 diseases both before and after the program began. To examine the effect of the cost-sharing policy on outpatient healthcare service utilization (percentage of general or tertiary hospital utilization, number of outpatient visits, and outpatient medical costs), a segmented regression analysis was performed. RESULTS After the policy to increase the coinsurance rate on prescription drug costs was implemented, the number of outpatient visits at general or tertiary hospitals decreased (β = -0.0114, p < 0.0001); however, the number increased at hospitals and clinics (β = 0.0580, p < 0.0001). Eventually, the number of outpatient visits to hospitals and clinics began to decrease after policy initiation (β = -0.0018, p < 0.0001). Outpatient medical costs decreased for both medical care organizations (general or tertiary hospitals: β = -2913.4, P < 0.0001; hospitals or clinics: β = -591.35, p < 0.0001), and this decreasing trend continued with time. CONCLUSIONS It is not clear that decreased utilization of general or tertiary hospitals has transferred to that of clinics or hospitals due to the increased cost-sharing policy of prescription drug costs. This result indicates the cost-sharing policy, intended to change patient behaviors for healthcare service utilization, has had limited effects on rebuilding the healthcare system and the function of medical care organizations.
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Affiliation(s)
- Hyo Jung Lee
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752 Republic of Korea
| | - Sung-In Jang
- Institute of Health Services Research, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752 Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752 Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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14
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Votapkova J, Zilova P. The abolition of user charges and the demand for ambulatory visits: evidence from the Czech Republic. HEALTH ECONOMICS REVIEW 2016; 6:29. [PMID: 27422120 PMCID: PMC4947065 DOI: 10.1186/s13561-016-0105-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 06/17/2016] [Indexed: 06/06/2023]
Abstract
This paper estimates the effect of the abolition of user charges for children's outpatient care (30 CZK/1.2 EUR) in 2009 on the demand for ambulatory doctor visits in the Czech Republic. Because the reform applied only to children, we can employ the difference-in-differences approach, where children constitute a treatment group and adults serve as a control group. The dataset covers 1841 observations. Aside from the treatment effect, we control for a number of personal characteristics using micro-level data (European Union Statistics on Income and Living Conditions). Using the zero-inflated negative binomial model, we found no significant effect from the abolition of user charges on doctor visits, suggesting either that user charges are ineffective in the Czech environment or that their value was set too low. On the contrary, personal income, the number of household members and gender have a significant effect. A number of robustness checks using restricted samples confirm the results.
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Affiliation(s)
- Jana Votapkova
- Institute of Economic Studies, Faculty of Social Sciences, Charles University, Opletalova 26, Prague, CZ-110 00 Czech Republic
| | - Pavlina Zilova
- Institute of Economic Studies, Faculty of Social Sciences, Charles University, Opletalova 26, Prague, CZ-110 00 Czech Republic
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Copayments and physicians visits: A panel data study of Swedish regions 2003-2012. Health Policy 2016; 120:1095-9. [PMID: 27477892 DOI: 10.1016/j.healthpol.2016.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 07/05/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This paper analyzes how primary care physician visits are affected by the level of copayment in Sweden. DATA SOURCE We use data between the years 2003-2012 from 21 Swedish health care regions that have the mandate to set their own level of copayment. The copayment per visit varies between €10 and €20 for these years and regions. STUDY DESIGN Our strategy to identify the causal effect and deal with unobserved endogeneity of price changes on physician visits is based on a panel data model using fixed effects to control for region and time and regional-variation in time trends. PRINCIPAL FINDING We cannot reject that the copayment has no statistical or economic effect of significance, and we estimate the "zero effect" with very high precision. CONCLUSION In a setting with sub-national regions with autonomy to set co-payments the results points to that the copayment is not an important predictor for the number of health care visits. The result is in line with some previous studies on European data where the range of copayments used tends to be relatively low.
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Petrou P. The Ariadne's thread in co-payment, primary health care usage and financial crisis: findings from Cyprus public health care sector. Public Health 2015; 129:1503-9. [DOI: 10.1016/j.puhe.2015.07.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 03/03/2015] [Accepted: 07/13/2015] [Indexed: 10/23/2022]
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Choi Y, Kim JH, Yoo KB, Cho KH, Choi JW, Lee TH, Kim W, Park EC. The effect of cost-sharing in private health insurance on the utilization of health care services between private insurance purchasers and non-purchasers: a study of the Korean health panel survey (2008-2012). BMC Health Serv Res 2015; 15:489. [PMID: 26510421 PMCID: PMC4624650 DOI: 10.1186/s12913-015-1153-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 10/25/2015] [Indexed: 11/12/2022] Open
Abstract
Background Private health insurance in South Korea mainly functions as supplementary and complementary health insurance that compensates for insufficient coverage by National Health Insurance. However, full private coverage of public sector cost-sharing led to the problem of encouraging moral hazard–induced utilization, resulting in a policy change that occurred in October 2009. At that time, the Korean government introduced a minimum cost-sharing policy for indemnity health insurance. The purpose of this study was to analyze the effect of cost-sharing in private health insurance on health care utilization. Methods We analyzed data collected from the Korean Health Panel Survey from October 2008 to December 2011. We restricted the two groups to 803 purchasers with indemnity health insurance and 7023 non-purchasers who did not obtain any private health insurance. A difference-in-difference analysis was used to evaluate the effect of the 2009 policy. Results After the policy change, the utilization of outpatient visits by purchasers gradually decreased more than non-purchasers (0.015 in 2009 [p = 0.758], −0.117 in 2010 [p < 0.016], and −0.140 in 2011 [p = 0.004]). However, utilization of inpatient services was not statistically significant. Notably, the magnitude of the cost-sharing effect in indemnity health insurance was stronger for those receiving medical aid. Among this group, utilization of outpatient services (after the policy change in 2009) decreased more so than non-purchasers. Patients with three or more chronic diseases have not changed their health care utilization. Conclusions Our results implied meaningful lessons for decision-makers and future health insurance policies in Korea and other countries in terms of cost-sharing in medical care. When policy makers intend to implement the cost-sharing, a different copayment scheme is needed according to the socioeconomic status or disease severity.
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Affiliation(s)
- Young Choi
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea. .,College of Medicine, Institute of Health Services Research, Yonsei University, Seoul, Korea.
| | - Jae-Hyun Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea. .,College of Medicine, Institute of Health Services Research, Yonsei University, Seoul, Korea.
| | - Ki-Bong Yoo
- Department of Healthcare Management, Eulji University, Seongnam, Korea.
| | - Kyoung Hee Cho
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea. .,College of Medicine, Institute of Health Services Research, Yonsei University, Seoul, Korea.
| | - Jae-Woo Choi
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea. .,College of Medicine, Institute of Health Services Research, Yonsei University, Seoul, Korea.
| | - Tae Hoon Lee
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea. .,College of Medicine, Institute of Health Services Research, Yonsei University, Seoul, Korea.
| | - Woorim Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea. .,College of Medicine, Institute of Health Services Research, Yonsei University, Seoul, Korea.
| | - Eun-Cheol Park
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea. .,College of Medicine, Institute of Health Services Research, Yonsei University, Seoul, Korea. .,Department of Preventive Medicine and Institute of Health Services Research, College of Medicine, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
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Kwak SY, Yoon SJ, Oh IH, Kim YE. An evaluation on the effect of the copayment waiver policy for Korean hospitalized children under the age of six. BMC Health Serv Res 2015; 15:170. [PMID: 25928166 PMCID: PMC4422598 DOI: 10.1186/s12913-015-0836-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 04/06/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In January 2006, the Korean government implemented a copayment waiver policy for hospitalized children under the age of 6 years to reduce the economic burden on patients. This policy was implemented from 2006 to 2007 in Korea and involved hospitalized children under the age of 6 years. The goal of this study is to evaluate the effect of the copayment waiver policy on health insurance beneficiaries. METHODS The change in medical service utilization before and after the policy implementation was analyzed using data from the national health insurance corporation (NHIC) and compared with medical aid beneficiaries who were already exempt from copayment. The "difference in difference" method was applied to determine the net effect of the copayment waiver policy. RESULTS The net effect of policy implementation on NHIC beneficiaries was unclear by the "difference in difference" method because the number of inpatient days and hospital expenditure after policy implementation showed opposite results. The copayment waiver policy did not decrease the intensity of health care utilization when compared with the medical aid beneficiaries group. Among the NHIC beneficiaries, patients who utilized medical services for fatal disease and those with the low premiums group were more affected by the policy. CONCLUSIONS The net effect of copayment waiver policy remains unclear. Therefore, further studies are needed to determine the effects of policies implemented to reduce the economic burden on patients, such as the herein-described copayment waiver policy.
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Affiliation(s)
- Sook Young Kwak
- Bureau of Welfare Administration Support, Ministry of Health and Welfare, Sejong, South Korea.
| | - Seok-Jun Yoon
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea.
| | - In-Hwan Oh
- Department of Preventive Medicine, College of Medicine, Kyung Hee University, Seoul, South Korea.
| | - Young-Eun Kim
- Division for Healthcare Technology Assessment Research, National Evidence-based healthcare Collaborating Agency (NECA), Seoul, South Korea.
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Bremer P. Forgone care and financial burden due to out-of-pocket payments within the German health care system. HEALTH ECONOMICS REVIEW 2014; 4:36. [PMID: 26208936 PMCID: PMC4502068 DOI: 10.1186/s13561-014-0036-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 11/27/2014] [Indexed: 06/07/2023]
Abstract
BACKGROUND The amount of out-of-pocket (OOP) payments within the German health care system has risen steadily within the last years. OOP payments aim to strengthen patients' cost awareness and try to restrict the demand on medical necessary treatments. However, besides the intended decline of non-induced health care services there's a risk that people also forgo necessary treatments because the utilization of health care services depends not only on need-factors but also on the ability to pay for it. Therefore, this paper aims to analyze the determinants of the total amount of OOP payments, the financial burden caused by OOP payments and the relinquishment of health care services due to OOP payments. DATA AND METHODS The empirical analysis is based on cross-sectional data of the German subsample (n = 2851) of the Survey of Health, Ageing and Retirement in Europe (SHARE). SHARE is a representative panel study among private households with persons above the age of 50 years and covers a wide range of topics, e.g. health behavior, health status and information about the socio-economic status. The analysis of the independent variables "total amount of OOP payments", "financial burden due to OOP payments" and "forgone care" is carried out by the means of descriptive as well as multivariate regression methods. RESULTS Individuals with low income as well as people suffering from chronic illnesses face a higher financial burden and forgo health care services more frequently at the same time. E.g. the financial burden of people who belong to the lowest income quintile is about eight times higher compared to individuals who belong to the highest quintile. The probability of forgone care for this group is about 5.6 percentage points higher [95% CI: 5.2 - 6.0]. CONCLUSION Especially for the group of people with chronic illnesses and low-income earners it cannot be ruled out that they also forgo necessary medical treatments due to the relatively high financial burden they face. Hence, it is required to facilitate the access to necessary care for these groups.
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Affiliation(s)
- Patrick Bremer
- Witten/Herdecke University, Chair for Institutional Economics and Health Policy, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany,
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Poulsen CA. Introducing out-of-pocket payment for general practice in Denmark: feasibility and support. Health Policy 2014; 117:64-71. [PMID: 24836020 DOI: 10.1016/j.healthpol.2014.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 03/21/2014] [Accepted: 04/08/2014] [Indexed: 11/16/2022]
Abstract
AIMS The financing of General Practice (GP) is a much-debated topic. In spite of out-of-pocket (OOP) payment for other primary health care provided by self-employed professionals, there is no OOP payment for the use of GP in Denmark. This article aims to explore the arguments, the actors and the decision-making context. METHODS AND MATERIALS An analysis of the healthcare-policy debate in Parliament and the media from 1990 until September 2012. The materials are parliamentary hearings/discussions and newspaper articles. Kingdon's model on Policy Windows and the Advocacy Coalition framework by Sabatier and Jenkins are used to investigate explanations. RESULTS The arguments from the proponents are: that OOP payment for GP will reduce pressure on the primary sector; that the current allocation of OOP payment in the sector is historically conditioned; and that resistance towards OOP payment is based on emotions. The main argument from the opponents is that OOP payment will increase social inequality in health. CONCLUSIONS There is little connection between the attitudes and ideological backgrounds of the political parties. Despite factors such as perceived expert/scientific evidence for OOP payment, changes of government, financial crisis and a market-based reform wave, no government has introduced OOP payment for GP. This article suggests that governmental positions, public- and especially health-professional support are important factors in the decision-making context.
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Affiliation(s)
- Camilla Aavang Poulsen
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen K, Denmark.
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Ziebarth NR. Assessing the effectiveness of health care cost containment measures: evidence from the market for rehabilitation care. ACTA ACUST UNITED AC 2013; 14:41-67. [PMID: 24306855 DOI: 10.1007/s10754-013-9138-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 11/13/2013] [Indexed: 10/26/2022]
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Schmitz H. Practice budgets and the patient mix of physicians - the effect of a remuneration system reform on health care utilisation. JOURNAL OF HEALTH ECONOMICS 2013; 32:1240-1249. [PMID: 24211757 DOI: 10.1016/j.jhealeco.2013.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 07/23/2013] [Accepted: 09/15/2013] [Indexed: 06/02/2023]
Abstract
This study analyses the effect of a change in the remuneration system for physicians on the treatment lengths as measured by the number of doctor visits using data from the German Socio-Economic Panel over the period 1995-2002. Specifically, I analyse the introduction of a remuneration cap (so called practice budgets) for physicians who treat publicly insured patients in 1997. I find evidence that the reform of 1997 did not change the extensive margin of doctor visits but strongly affected the intensive margin. The conditional number of doctor visits among publicly insured decreased while it increased among privately insured. This can be seen as evidence that physicians respond to the change in incentives induced by the reform by altering their patient mix.
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Farbmacher H, Winter J. Per-period co-payments and the demand for health care: evidence from survey and claims data. HEALTH ECONOMICS 2013; 22:1111-1123. [PMID: 23775670 DOI: 10.1002/hec.2955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 05/05/2013] [Accepted: 05/08/2013] [Indexed: 06/02/2023]
Abstract
When health insurance reforms involve non-linear price schedules tied to payment periods (for example, fees levied by quarter or year), the empirical analysis of its effects has to take the within-period time structure of incentives into account. The analysis is further complicated when demand data are obtained from a survey in which the reporting period does not coincide with the payment period. We illustrate these issues using as an example a health care reform in Germany that imposed a per-quarter fee of €10 for doctor visits and additionally set an out-of-pocket maximum. This co-payment structure results in an effective 'spot' price for a doctor visit that decreases over time within each payment period. Taking this variation into account, we find a substantial reform effect-especially so for young adults. Overall, the number of doctor visits decreased by around 9% in the young population. The probability of visiting a physician in any given quarter decreased by around 4 to 8 percentage points.
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Affiliation(s)
- Helmut Farbmacher
- Max Planck Society, Munich Center for the Economics of Aging, Munich, Germany.
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Kroll LE, Lampert T. Direct costs of inequalities in health care utilization in Germany 1994 to 2009: a top-down projection. BMC Health Serv Res 2013; 13:271. [PMID: 23844804 PMCID: PMC3728043 DOI: 10.1186/1472-6963-13-271] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 07/03/2013] [Indexed: 11/30/2022] Open
Abstract
Background Social inequalities in health are a characteristic of almost all European Welfare States. It has been estimated, that this is associated with annual costs that amount to approximately 9% of total member state GDP. We investigated the influence of inequalities in German health care utilization on direct medical costs. Methods We used longitudinal data from a representative panel study (German Socio-Economic Panel Study) covering 1994 to 2010. The sample consisted of respondents aged 18 years or older. We used additional data from the German Health Interview and Examination Survey for Children and Adolescents, conducted between 2003 and 2006, to report utilization for male and female participants aged from 0 to 17 years. We analyzed inequalities in health care using negative binomial regression models and top-down cost estimates. Results Men in the lowest income group (less than 60% of median income) had a 1.3-fold (95% CI: 1.2-1.4) increased number of doctor visits and a 2.2-fold (95% CI: 1.9-2.6) increased number of hospital days per year, when compared with the highest income group; the corresponding differences were 1.1 (95% CI: 1.0-1.1) and 1.3 (95% CI: 1.2-1.5) for women. Depending on the underlying scenario used, direct costs for health care due to health inequalities were increased by approximately 2 billion to 25 billion euros per year. The best case scenario (the whole population is as healthy and uses an equivalent amount of resources as the well-off) would have hypothetically reduced the costs of health care by 16 to 25 billion euros per year. Conclusions Our findings indicate that inequalities and inequities in health care utilization exist in Germany, with respect to income position, and are associated with considerable direct costs. Additional research is needed to analyze the indirect costs of health inequalities and to replicate the current findings using different methodologies.
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Eibich P, Ziebarth NR. Analyzing regional variation in health care utilization using (rich) household microdata. Health Policy 2013; 114:41-53. [PMID: 23706385 DOI: 10.1016/j.healthpol.2013.04.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 02/18/2013] [Accepted: 04/19/2013] [Indexed: 01/08/2023]
Abstract
This paper exploits rich SOEP microdata to analyze state-level variation in health care utilization in Germany. Unlike most studies in the field of the Small Area Variation (SAV) literature, our approach allows us to net out a large array of individual-level and state-level factors that may contribute to the geographic variation in health care utilization. The raw data suggest that state-level hospitalization rates vary from 65 to 165 percent of the national mean. Ambulatory doctor visits range from 90 to 120 percent of the national mean. Interestingly, in the former GDR states, doctor visit rates are significantly below the national mean, while hospitalization rates lie above the national mean. The significant state-level differences vanish once we control for individual-level socio-economic characteristics, the respondents' health status, their health behavior as well as supply-side state-level factors.
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Affiliation(s)
- Peter Eibich
- DIW Berlin, Mohrenstrasse 58, 10117 Berlin, Germany; University of Hamburg, Germany.
| | - Nicolas R Ziebarth
- Cornell University, Policy Analysis and Management (PAM), 106 Martha van Rensselaer Hall, Ithaca, NY 14853, United States; DIW Berlin, Germany; IZA Bonn, Germany.
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Kim HJ, Kim YH, Kim HS, Woo JS, Oh SJ. The Impact of Outpatient Coinsurance Rate Increase on Outpatient Healthcare Service Utilization in Tertiary and General Hospital. HEALTH POLICY AND MANAGEMENT 2013. [DOI: 10.4332/kjhpa.2013.23.1.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Wolfenstetter SB, Menn P, Holle R, Mielck A, Meisinger C, von Lengerke T. Body weight changes and outpatient medical care utilisation: Results of the MONICA/KORA cohorts S3/F3 and S4/F4. PSYCHO-SOCIAL MEDICINE 2012; 9:Doc09. [PMID: 23133503 PMCID: PMC3488805 DOI: 10.3205/psm000087] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives: To test the effects of body weight maintenance, gain, and loss on health care utilisation in terms of outpatient visits to different kinds of physicians in the general adult population. Methods: Self-reported utilisation data were collected within two population-based cohorts (baseline surveys: MONICA-S3 1994/95 and KORA-S4 1999/2001; follow-ups: KORA-F3 2004/05 and KORA-F4 2006/08) in the region of Augsburg, Germany, and were pooled for present purposes. N=5,147 adults (complete cases) aged 25 to 64 years at baseline participated. Number of visits to general practitioners (GPs), internists, and other specialists as well as the total number of physician visits at follow-up were compared across 10 groups defined by body mass index (BMI) category maintenance or change. Body weight and height were measured anthropometrically. Hierarchical generalized linear regression analyses with negative binomial distribution adjusted for sex, age, socioeconomic status (SES), survey, and the need factors incident diabetes and first cancer between baseline and follow-up were conducted. Results: In fully adjusted models, compared to the group of participants that maintained normal weight from baseline to follow-up, the following groups had significantly higher GP utilisation rates: weight gain from normal weight (+36%), weight loss from preobesity (+39%), maintained preobesity (+34%), weight gain after preobesity (+43%), maintained moderate obesity (+48%), weight gain from moderate obesity (+107%), weight loss from severe obesity (+114%), and maintained severe obesity (+83%). Regarding internists, those maintaining moderate obesity reported +107% more visits; those with weight gain from moderate obesity reported +91%. The latter group also had +41% more consultations with other physicians. Across all physicians, mean number of visits were estimated at 7.8 per year for maintained normal weight, 9 for maintained preobesity, 11 for maintained moderate obesity, and 12 for maintained severe obesity. Among those with weight loss, the mean number of visits were 8.7, 10.6 and 10.8 for baseline preobesity, moderate obesity, and severe obesity, respectively. Finally, those with weight gain from normal weight and preobesity reported 9.4 and 9.3 visits, respectively, and those with baseline moderate and follow-up severe obesity reported 13.1 visits (the most overall). Women reported higher GP and other physician utilisation. While all utilisation rates increased with age, GP utilisation was lower in middle to high SES groups. Conclusion: Compared to maintained normal weight over a 7- to 10-year period, maintained overweight, weight gain and weight loss are associated with higher outpatient physician utilisation in adults, especially after baseline obesity. These effects only partly became insignificant after inclusion of incident diabetes or first cancer into the model. Future research should further elucidate the associations between weight development and health care utilisation by BMI status and the mechanisms underlying these associations.
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Affiliation(s)
- Silke B Wolfenstetter
- Helmholtz Zentrum München - German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany
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Huber CA, Rüesch P, Mielck A, Böcken J, Rosemann T, Meyer PC. Effects of cost sharing on seeking outpatient care: a propensity-matched study in Germany and Switzerland. J Eval Clin Pract 2012; 18:781-7. [PMID: 21518398 DOI: 10.1111/j.1365-2753.2011.01679.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Several studies have assessed the effect of cost sharing on health service utilization (HSU), mostly in the USA. Results are heterogeneous, showing different effects. Whereas previous studies compared insurants within one health care system but different modes of insurance, we aimed at comparing two different health care systems in Europe: Germany and Switzerland. Furthermore, we assessed the impact of cost sharing depending on socio-demographic factors as well as health status. METHODS Two representative samples of 5197 Swiss insurants with and 5197 German insurants without cost sharing were used to assess the independent association between cost sharing and the use of outpatient care. To minimize confounding, we performed cross-sectional analyses between propensity score matched Swiss and German insurants. We investigated subgroups according to health and socio-economic status to assess a potential social gradient in HSU. RESULTS We found a significant association between health insurance scheme and the use of outpatient services. German insurants without cost sharing (visit rate: 4.8 per year) consulted a general practitioner or specialist more frequently than Swiss insurants with cost sharing (visit rate: 3.0 per year; P < 0.01). Subgroup analyses showed that vulnerable populations were differently affected by cost sharing. In the group of respondents with poor health and low socio-economic status, the cost-sharing effect was strongest. CONCLUSION Cost-sharing models reduce HSU. The challenge is to create cost-sharing models which do not preclude vulnerable populations from seeking essential health care.
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Affiliation(s)
- Carola A Huber
- Head of Department, Institute of General Practice and Health Services Research, University of Zürich, Zürich, Switzerland.
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The effects of unethical conduct of pharmaceutical companies on consumer behavior. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2012. [DOI: 10.1108/17506121211243040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Schupp J. Das Sozio-oekonomische Panel (SOEP). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55:767-74. [DOI: 10.1007/s00103-012-1496-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Skriabikova O, Pavlova M, Groot W. Empirical models of demand for out-patient physician services and their relevance to the assessment of patient payment policies: a critical review of the literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2010; 7:2708-25. [PMID: 20644697 PMCID: PMC2905574 DOI: 10.3390/ijerph7062708] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 06/10/2010] [Accepted: 06/21/2010] [Indexed: 11/22/2022]
Abstract
This paper reviews the existing empirical micro-level models of demand for out-patient physician services where the size of patient payment is included either directly as an independent variable (when a flat-rate co-payment fee) or indirectly as a level of deductibles and/or co-insurance defined by the insurance coverage. The paper also discusses the relevance of these models for the assessment of patient payment policies. For this purpose, a systematic literature review is carried out. In total, 46 relevant publications were identified. These publications are classified into categories based on their general approach to demand modeling, specifications of data collection, data analysis, and main empirical findings. The analysis indicates a rising research interest in the empirical micro-level models of demand for out-patient physician services that incorporate the size of patient payment. Overall, the size of patient payments, consumer socio-economic and demographic features, and quality of services provided emerge as important determinants of demand for out-patient physician services. However, there is a great variety in the modeling approaches and inconsistencies in the findings regarding the impact of price on demand for out-patient physician services. Hitherto, the empirical research fails to offer policy-makers a clear strategy on how to develop a country-specific model of demand for out-patient physician services suitable for the assessment of patient payment policies in their countries. In particular, theoretically important factors, such as provider behavior, consumer attitudes, experience and culture, and informal patient payments, are not considered. Although we recognize that it is difficult to measure these factors and to incorporate them in the demand models, it is apparent that there is a gap in research for the construction of effective patient payment schemes.
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Affiliation(s)
- Olga Skriabikova
- Department of Health Organization, Policy and Economics, CAPHRI, Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; E-Mails: (M.P.); (W.G.)
- Research Center for Education and the Labour Market (ROA), School of Business and Economics, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Milena Pavlova
- Department of Health Organization, Policy and Economics, CAPHRI, Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; E-Mails: (M.P.); (W.G.)
| | - Wim Groot
- Department of Health Organization, Policy and Economics, CAPHRI, Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; E-Mails: (M.P.); (W.G.)
- Topinstitute Evidence Based Education Research (TIER), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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