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Jo S, Jun DB, Park S. Impact of differential copayment on patient healthcare choice: evidence from South Korean National Cohort Study. BMJ Open 2021; 11:e044549. [PMID: 34162638 PMCID: PMC8231052 DOI: 10.1136/bmjopen-2020-044549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE We evaluate the effectiveness of mild disease differential copayment policy aimed at reducing unnecessary patient visits to secondary/tertiary healthcare institutions in South Korea. DESIGN Retrospective study using difference-in-difference design. SETTING Sample Research database provided by the Korean National Health Insurance Service, between 2010 and 2013. PARTICIPANTS 206 947 patients who visited healthcare institutions to treat mild diseases during the sample period. METHODS A linear probability model with difference-in-difference approach was adopted to estimate the changes in patients' healthcare choices associated with the differential copayment policy. The dependent variable was a binary variable denoting whether a patient visited primary healthcare or secondary/tertiary healthcare to treat her/his mild disease. Patients' individual characteristics were controlled with a fixed effect. RESULTS We observed significant decrease in the proportion of patients choosing secondary/tertiary healthcare over primary healthcare by 2.99 per cent point. The decrease associated with the policy was smaller by 14% in the low-income group compared with richer population, greater by 19% among the residents of Seoul metropolitan area than among people living elsewhere, and greater among frequent healthcare visitors by 33% than among people who less frequently visit healthcare. CONCLUSION The mild disease differential copayment policy of South Korea was successful in discouraging unnecessary visits to secondary/tertiary healthcare institutions to treat mild diseases that can be treated well in primary healthcare.
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Affiliation(s)
- Sangkyun Jo
- College of Business, KAIST, Seoul, South Korea
| | - Duk Bin Jun
- College of Business, KAIST, Seoul, South Korea
| | - Sungho Park
- SNU Business School, Seoul National University, Seoul, South Korea
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Park E, Choi S. Who Benefits from the Fixed Copayment of Medical and Pharmaceutical Expenditure among the Korean Elderly? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218118. [PMID: 33153173 PMCID: PMC7663709 DOI: 10.3390/ijerph17218118] [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: 09/14/2020] [Revised: 10/26/2020] [Accepted: 11/01/2020] [Indexed: 06/11/2023]
Abstract
The Korean National Health Insurance system imposes a 30% coinsurance for outpatient medical care and prescription drugs; however, at the age of 65, the coinsurance model changes to a copayment model that offers lower fees for the elderly. Thus, this study aimed to investigate the influence of the copayment model for outpatient visits and prescription drugs on healthcare utilization among the Korean elderly. We compared total outpatient visits, total prescriptions, and out-of-pocket expenses between a case group with copayment reduction (65 years or older) and a control group without any reduction (64 years or younger). We obtained secondary data collected from seven waves of the Korea Health Panel Survey (2010-2016). Outpatient visits increased exclusively in the case group among those with lower income. After adjusting for covariates, the results of the difference-in-differences analysis showed that, compared to the control group, there was a significant increase in outpatient visits among individuals with lower income in the case group. Our study shows that cost sharing changes affect Korean patients with different income levels in different ways.
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Affiliation(s)
- Eunja Park
- Korea Institute for Health and Social Affairs, Sejong 30147, Korea;
| | - Sookja Choi
- Red Cross College of Nursing, Chung-Ang University, Seoul 06974, Korea
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Age Structural Transitions and Copayment Policy Effectiveness: Evidence from Taiwan's National Health Insurance System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124183. [PMID: 32545433 PMCID: PMC7344636 DOI: 10.3390/ijerph17124183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/03/2020] [Accepted: 06/10/2020] [Indexed: 11/17/2022]
Abstract
Background: Population ageing is a worldwide phenomenon that could influence health policy effectiveness. This research explores the impact of age structural transitions on copayment policy responses under Taiwan’s National Health Insurance (NHI) system. Methods: The time-varying parameter vector autoregressive model was applied to create two measures of the copayment policy effectiveness, and multiple linear regression models were used to verify the nonlinear effect of age structural transitions on copayment policy responses. Results: Our results show that copayment policy effectiveness (in terms of the negative response of medical center outpatient visits to upward adjustments in copayment) is positively correlated with the proportions of the population in two older age groups (aged 55–64 and ≥ 65) and children (age < 15), but negatively correlated with the proportion of the population that makes up most of the workforce (aged 15‒54). These tendencies of age distribution, which influence the responses of medical center outpatient visits to copayment policy changes, predict that copayment policy may have a greater influence on medical center outpatient utilization in an ageing society. Conclusions: Policymakers should be concerned about the adverse effects of copayment adjustments on the elderly, such as an increasing financial burden and the effect of pricing some elderly patients out of Taiwan’s NHI system.
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Hone T, Lee JT, Majeed A, Conteh L, Millett C. Does charging different user fees for primary and secondary care affect first-contacts with primary healthcare? A systematic review. Health Policy Plan 2017; 32:723-731. [PMID: 28453713 DOI: 10.1093/heapol/czw178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 11/14/2022] Open
Abstract
Policy-makers are increasingly considering charging users different fees between primary and secondary care (differential user charges) to encourage utilisation of primary health care in health systems with limited gate keeping. A systematic review was conducted to evaluate the impact of introducing differential user charges on service utilisation. We reviewed studies published in MEDLINE, EMBASE, the Cochrane library, EconLIT, HMIC, and WHO library databases from January 1990 until June 2015. We extracted data from the studies meeting defined eligibility criteria and assessed study quality using an established checklist. We synthesized evidence narratively. Eight studies from six countries met our eligibility criteria. The overall study quality was low, with diversity in populations, interventions, settings, and methods. Five studies examined the introduction of or increase in user charges for secondary care, with four showing decreased secondary care utilisation, and three showing increased primary care utilisation. One study identified an increase in primary care utilisation after primary care user charges were reduced. The introduction of a non-referral charge in secondary care was associated with lower primary care utilisation in one study. One study compared user charges across insurance plans, associating higher charges in secondary care with higher utilisation in both primary and secondary care. Overall, the impact of introducing differential user-charges on primary care utilisation remains uncertain. Further research is required to understand their impact as a demand side intervention, including implications for health system costs and on utilisation among low-income patients.
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Affiliation(s)
- Thomas Hone
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London
| | - John Tayu Lee
- Saw Swee Hock School of Public Health, National University of Singapore
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London
| | - Lesong Conteh
- Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London
| | - Christopher Millett
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London
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Bae B, Choi BR, Song I. The impact of change from copayment to coinsurance on medical care usage and expenditure in outpatient setting in older Koreans. Int J Health Plann Manage 2017; 33:235-245. [PMID: 28370318 DOI: 10.1002/hpm.2416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 03/02/2017] [Indexed: 11/07/2022] Open
Abstract
Patient cost-sharing change was implemented on August 1, 2007, for outpatient care in the clinic setting in Korea from copayment to coinsurance. This study aims to estimate the effect of the policy change on medical care usage and expenditure in older Koreans. By using national health insurance claims data from the Health Insurance Reimbursement Assessment Service, this study analyzed the entire 137 million claims for a total of approximately 4.1 million patients aged 60 to 69 years who had been diagnosed and/or treated for outpatient care in clinics from January 1, 2007, to December 31, 2008. Medical care usage was defined as the proportion of all beneficiaries in each group who visited clinics and the mean number of visit days per beneficiary. Medical care expenditure per visit day was expressed as total costs, reimbursed amount, and patient's out-of-pocket payment. Data on January through June of 2008 were analyzed as compared with the same months of 2007. Raw difference-in-difference and multiple regression analyses were performed. The interaction coefficients, which measured the impact of cost-sharing change, was -0.078 in model 1 and -0.039 in model 2 (P < .0001). In conclusion, a cost-sharing change from copayment to coinsurance reduced medical care usage and expenditure.
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Affiliation(s)
- Byoungjun Bae
- Bureau of Health Policy, Ministry of Health and Welfare, Sejong, South Korea
| | - Bo Ram Choi
- Department of Nursing, Yong-In Songdam College, Yongin-si, Gyeonggi-do, South Korea
| | - Inmyung Song
- Division of Risk Assessment and International Cooperation, Korea Centers for Disease Control and Prevention, Cheongju, South Korea
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Yoo KB, Ahn HU, Park EC, Kim TH, Kim SJ, Kwon JA, Lee SG. Impact of co-payment for outpatient utilization among Medical Aid beneficiaries in Korea: A 5-year time series study. Health Policy 2016; 120:960-6. [DOI: 10.1016/j.healthpol.2016.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 10/21/2022]
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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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Wu MH, Wu MJ, Chou LF, Chen TJ. Patterns of nonemergent visits to different healthcare facilities on the same day: a nationwide analysis in Taiwan. ScientificWorldJournal 2014; 2014:627580. [PMID: 24892063 PMCID: PMC4032646 DOI: 10.1155/2014/627580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 04/02/2014] [Indexed: 11/20/2022] Open
Abstract
Doctor shopping is a common phenomenon in many countries. However, patterns of switching healthcare facilities on the same day were little known. The data were obtained from the longitudinal cohort datasets (LHID2010) of Taiwan's National Health Insurance Research Database in 2010. Of 1,000,000 persons of the cohort with 13,276,928 nonemergent visits, 185,347 patients had visited different healthcare facilities within one day, with a total of 672,478 visits and 337,260 switches between facilities in 329,073 patient-days. While 63.0% (n = 212,590) of all switches occurred between facilities of the same accreditation level, 14.1% (n = 47,664) moved from lower to higher level, and 22.8% (n = 77,006) moved in the opposite direction. In 33,689 switches, patients moved to the same specialty of another facility. In 48,324 switches, patients moved to another facility with the same diagnosis, and the most frequent diagnoses were diseases of the digestive system (11,148) and diseases of the respiratory system (10,393). In a densely populated country without strict referral regulation, a high percentage of Taiwanese people had the experience of visiting different healthcare facilities on the same day. The system of family physicians as personal doctors and gatekeepers to healthcare might ameliorate the harmful impact.
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Affiliation(s)
- Meng-Hsuan Wu
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
| | - Meng-Ju Wu
- Faculty of Medicine, Semmelweis University, Budapest 1094, Hungary
| | - Li-Fang Chou
- Department of Public Finance, National Chengchi University, Taipei 116, Taiwan
| | - Tzeng-Ji Chen
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
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Lkhagva D, Gao Y, Babazono A. Does co-payment rate influence the relationship between monthly salary and health care service demand among the insured of health insurance societies in Japan? Popul Health Manag 2012; 16:58-63. [PMID: 22823294 DOI: 10.1089/pop.2011.0094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The co-payment rate for health care services for insured people increased from 10% to 20% in 1997, and then to 30% in 2003 under the Employed Health Insurance System in Japan. The purpose of this study is to quantify the relationship between average monthly salary and health care service demand by different co-payment rates among the insured of health insurance societies in Japan. Data from the National Federation of Health Insurance Societies from 1996, 2002, and 2007 were analyzed. Indicators of health care service demand included case rates and number of service days per case for inpatient, outpatient, and dental services. The authors evaluated the relationship of average monthly salary with these indicators using multiple regression analyses for each of the 3 years. In the study, the average monthly salary showed a high positive correlation with outpatient and dental case rates for all 3 years. The magnitude of the relationship of average monthly salary to health care service demand was intensified as patient co-payment increased from 10% to 20%. However, it did not change when the co-payment increased from 20% to 30%. The increase in patient co-payment rate from 20% to 30% did not intensify the relationship between average monthly salary and health care service demand among the insured of health insurance societies in Japan.
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Affiliation(s)
- Dulamsuren Lkhagva
- Department of Health Services Management and Policy, Graduate School of Healthcare Sciences, Kyushu University, Fukuoka, Japan
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Chen LC, Lee YY, Lin TH, Lee CS, Li CJ, Wu DC. How Does Out-of-Pocket Payment Affect Choices When Accessing Health Care?-A Qualitative Study on Hypertensive Outpatients in Southern Taiwan. Value Health Reg Issues 2012; 1:105-110. [PMID: 29702816 DOI: 10.1016/j.vhri.2012.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The National Health Insurance in Taiwan provides the entire population with universal coverage and full freedom to access health care, and thus results in accelerating medical utilization and costs. A differential outpatient co-payment was introduced on July 15, 2005, to deter nonessential visits and encourage initial contact in primary care and a stepwise access to health care (referral system). A previous study, however, showed a limited impact of this co-payment policy on reducing medical utilization and improving the referral system. This qualitative study aimed to explore Taiwanese patients' decision-making process to access health care and how the cost issue impacts patients' access to health care and explore patients' cost-saving strategies. METHODS Hypertensive patients from different tiers of medical facilities (community, regional hospitals, and medical centers) in the Kao-Ping area of southern Taiwan were invited to participate in focus groups from October 2008 to January 2009. RESULTS Of all, 40 participants were recruited for nine focus groups. The physicians' reputation, tiers of hospitals, and the convenience of transport and registration are the three major reasons why participants accessed different medical facilities. Participants expressed that the current out-of-pocket payment is affordable and not as important as other reasons for their choices. Continuous prescription was considered a cost-saving strategy for patients visiting higher tiers of medical facilities. Most participants were not fully aware of current National Health Insurance regulations such as co-payment, continuous prescriptions, and the referral policy. CONCLUSIONS The current out-of-pocket payment is affordable for hypertensive patients receiving regular treatments, but it fails to reduce the demand of health care. To establish a proper evaluation of the co-payment policy, future study is suggested to consider the views from health care providers and financially vulnerable patients.
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Affiliation(s)
- Li-Chia Chen
- Division for Social Research in Medicines and Health, School of Pharmacy, University of Nottingham, Nottingham, UK; Graduate Institute of Clinical Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
| | - Yung-Ying Lee
- Graduate Institute of Clinical Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC; Department of Internal Medicine, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Chee-Siong Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC; Department of Internal Medicine, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Chuen-Jing Li
- Department of Pharmacy, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
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Barriers to health care among the elderly in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2010; 7:1330-41. [PMID: 20617033 PMCID: PMC2872331 DOI: 10.3390/ijerph7041330] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 03/09/2010] [Accepted: 03/15/2010] [Indexed: 11/28/2022]
Abstract
Japan is undergoing a set of health care reforms aimed at cutting rising health care costs and increasing the efficiency of health care delivery. This empirical study used a large-scale community survey on 15,302 elderly people 65 years and older (56.0% women) conducted in seven municipalities in 2006, to reveal clear-cut evidence of barriers to necessary care. The reasons for not getting health care is attributed to health care cost for the elderly with lower income, while higher income counterparts reported being busy or having a condition not serious enough to seek care.
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Chen LC, Schafheutle EI, Noyce PR. The impact of nonreferral outpatient co-payment on medical care utilization and expenditures in Taiwan. Res Social Adm Pharm 2009; 5:211-24. [DOI: 10.1016/j.sapharm.2008.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Revised: 08/07/2008] [Accepted: 08/08/2008] [Indexed: 10/21/2022]
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