The impact of differential cost sharing of prescription drugs on the use of primary care clinics among patients with hypertension or diabetes

Park, Eunja; Kim, Daeeun; Choi, Sookja

doi:10.1016/j.puhe.2019.05.005

Cited by 10 publications

(12 citation statements)

References 28 publications

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“…Consequently, cancer patients in South Korean can now visit medical institutions of their choice and receive cancer diagnosis and treatment by paying only 5% of the total medical cost. However, there is no strict gatekeeping system for controlling healthcare utilization, and it is relatively easy for patients to access primary and secondary care as well as services in tertiary hospitals [ 15 ]. Although oncologists or other physicians may refer patients to other hospitals, in South Korea, patients’ intention to visit superior or mega-sized hospitals drives institutional transition of cancer care.…”

Section: Introductionmentioning

confidence: 99%

Association of institutional transition of cancer care with mortality in elderly patients with lung cancer: a retrospective cohort study using national claim data

et al. 2022

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Background Although survival based outcomes of lung cancer patients have been well developed, institutional transition of cancer care, that is, when patients transfer from primary visiting hospitals to other hospitals, and mortality have not yet been explored using a large-scale representative population-based sample. Methods Data from the Korean National Elderly Sampled Cohort survey were used to identify patients with lung cancer who were diagnosed during 2005–2013 and followed up with for at least 1 year after diagnosis (3738 patients with lung cancer aged over 60 years). First, the authors examined the distribution of the study population by mortality, and Kaplan-Meier survival curves/log-rank test were used to compare mortality based on institutional transition of cancer care. Survival analysis using the Cox proportional hazard model was conducted after controlling for all other variables. Results Results showed that 1-year mortality was higher in patients who underwent institutional transition of cancer care during 30 days after diagnosis (44.2% vs. 39.7%, p = .027); however, this was not associated with 5-year mortality. The Cox proportional hazard model showed that patients who underwent institutional transition of cancer care during 30 days after diagnosis exhibited statistically significant associations with high mortality for 1 year and 5 years (1-year mortality, Hazard ratio [HR]: 1.279, p = .001; 5-year mortality, HR: 1.158, p = .002). Conclusion This study found that institutional transition of cancer care was associated with higher mortality among elderly patients with lung cancer. Future consideration should also be given to the limitation of patients’ choice when opting for institutional transition of care since there are currently no control mechanisms in this regard. Results of this study merit health policymakers’ attention.

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Section: Introductionmentioning

confidence: 99%

Association of institutional transition of cancer care with mortality in elderly patients with lung cancer: a retrospective cohort study using national claim data

et al. 2022

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“…In addition, some studies have reported that adjusting the prescription drug copayment can effectively induce chronic patients to use clinics to manage their diseases. Moreover, under current policy, patients with chronic and mild diseases impose a more significant cost burden than acute patients [ 14 , 15 ]. However, a higher copayment causes low-income people and patients with chronic disease to reduce their use of primary care, which might result in worse health.…”

Section: Introductionmentioning

confidence: 99%

“…This would in turn lead to high-cost treatment [ 16 ]. As reviewed previously, it could be necessary to ensure high-quality services and charge an appropriate copayment to encourage chronic and mild patients to use the appropriate hospital levels [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

A Study of Patients’ Willingness to Pay for a Basic Outpatient Copayment and Medical Service Quality in Taiwan

Hsu

Yang

Fan

2021

IJERPH

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Patients might be willing to pay more to obtain better quality medical services when they recognize that high-level hospitals have better quality. However, published papers have not found solid empirical evidence to support this possibility. Therefore, the purpose of this study is to empirically investigate patients’ willingness to pay (WTP) for an outpatient copayment. The study aims to analyze the difference between the two WTP values: to implement a hierarchy of medical care and to improve the quality of medical services. This study administered a questionnaire using the contingent valuation method with a quasi-bidding game for patients’ WTP and the SERVQUAL scale for medical service quality. The Wilcoxon signed-rank test was employed to test the difference between the two WTP values, notably to implement a hierarchy of medical care and to improve the quality of medical services. Both of the WTP values are higher than the academic medical centre’s current copayment NT$420 (approximately US$14); the percentage of respondents willing to pay a higher copayment declined when the outpatient copayment was increased, and the patients’ WTP to have better medical service quality was significantly higher than that to implement a hierarchy of medical care. Patients’ desire to receive better medical services from higher-level hospitals might be stronger than their desire to implement hierarchical medical care. This study reported the relationship between the respondents’ perceived medical service quality and WTP for having better service quality by using regression models. The respondents’ perceptions of medical service quality, especially for “reliability” and “assurance,” would positively affect their WTP. Policy makers should focus on improving the quality of medical services.

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“…There have been a few empirical studies that investigated the effect of differential copayment policy of South Korea but they had the same limitations as the above cited papers-namely, no rigorous handling of the confounding effects. [21][22][23] Hone et al 24 performed a systematic review to evaluate the impact of introducing differential user charges on healthcare service utilisation. They found that the introduction of or increase in user charges for secondary care are associated with decreased secondary care utilisation.…”

Section: Introductionmentioning

confidence: 99%

Impact of differential copayment on patient healthcare choice: evidence from South Korean National Cohort Study

Jun

Park

2021

BMJ Open

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ObjectiveWe evaluate the effectiveness of mild disease differential copayment policy aimed at reducing unnecessary patient visits to secondary/tertiary healthcare institutions in South Korea.DesignRetrospective study using difference-in-difference design.SettingSample Research database provided by the Korean National Health Insurance Service, between 2010 and 2013.Participants206 947 patients who visited healthcare institutions to treat mild diseases during the sample period.MethodsA 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.ResultsWe 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.ConclusionThe 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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The impact of differential cost sharing of prescription drugs on the use of primary care clinics among patients with hypertension or diabetes

Cited by 10 publications

References 28 publications

Association of institutional transition of cancer care with mortality in elderly patients with lung cancer: a retrospective cohort study using national claim data

Association of institutional transition of cancer care with mortality in elderly patients with lung cancer: a retrospective cohort study using national claim data

A Study of Patients’ Willingness to Pay for a Basic Outpatient Copayment and Medical Service Quality in Taiwan

Impact of differential copayment on patient healthcare choice: evidence from South Korean National Cohort Study

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