The Effect of Copayment on Medical Aid Beneficiaries in Korea

PURPOSE: This study was to ascertain whether there are differences in health care utilization and expenditure for Type I Medical Aid Beneficiaries before and after applying Copayment. METHODS: This study was one-group pretest posttest design study using secondary data analysis. Data for pretest group were collected from claims data of the Korea National Health Insurance Corporation and data for posttest group were collected through door to-door interviews using a structured questionnaire. A total of 1,364 subjects were sampled systematically from medical aid beneficiaries who had applied for copayment during the period from December 12, 2007 to September 25, 2008. RESULTS: There was no negative effect of copayment on accessibility to medical services, medication adherence (p=.94), and quality of life (p=.25). Some of the subjects' health behaviors even increased preferably after applying for copayment including flu prevention (p<.001), health care examination (p=.035), and cancer screening (p=.002). However, significant suppressive effects of copayment were found on outpatient hospital visiting days (p<.001) and outpatient medical expenditure (p<.001). CONCLUSION: Copayment does not seem to be a great influencing factor on beneficiaries'accessibility to medical services and their health behavior even though it has suppressive effects on outpatients' use of health care.

User charges in health care: Evidence of effect on service utilization & equity from north India.

Background & objectives: User charges have been advocated on efficiency grounds despite the widespread criticism about their adverse effect on equity. We assessed the effect of user charges on inpatient hospitalizations rate and equity in Haryana State. Methods: The inpatient department (IPD) statistics of the public sector facilities in Yamuna Nagar district where user charges had been introduced were analysed and compared with Rohtak district which did not have user charge between 2000 and 2006. National Sample Survey data of Haryana for the 2004-2005 period were analyzed to compare utilization of public sector facilities for hospitalization, cost of hospitalization, and prevalence of catastrophic out-of-pocket (OOP) expenditure by income quintiles in three districts which had user charges and 17 districts of Haryana which did not levy user charges. Results: During 2000 and 2006, hospital admissions declined by 23.8 per cent in Yamuna Nagar district where user charges had been introduced compared to an almost static hospitalization rate in Rohtak district which did not have user charges (P<0.01). Public sector hospital utilization for inpatient services had a pro-rich (concentration index 0.144) distribution in the three districts with user charges and pro-poor (concentration index -0.047) in the 17 districts without user charges. Significantly higher prevalence of catastrophic health expenditure was observed in public sector institutions with user charges (48%) compared to those without user charges (35.4%) (P<0.001). Interpretation & conclusions: The findings of our study showed that user charges had a negative influence on hospitalizations in Haryana especially among the poor. Public policies for revenue generation should avoid user charges.

The Effect of Outpatient Cost Sharing on Health Care Utilization of the Elderly / 예방의학회지

OBJECTIVES: The purpose of this study was to analyze the effect of outpatient cost-sharing on health care utilization by the elderly. METHODS: The data in this analysis was the health insurance claims data between July 1999 and December 2008 (114 months). The study group was divided into two age groups, namely 60-64 years old and 65-69 years old. This study evaluated the impact of policy change on office visits, the office visits per person, and the percentage of the copayment-paid visits in total visits. Interrupted time series and segmented regression model were used for statistical analysis. RESULTS: The results showed that outpatient cost-sharing decreased office visits, but it also decreased the percentage of copayment-paid visits, implying that the intensity of care increased. There was little difference in the results between the two age groups. But after the introduction of the coinsurance system for those patients under age 65, office visits and the percentage of copayment-paid visits decreased, and the 60-64 years old group had a larger decrease than the 65-69 years old group. CONCLUSIONS: This study evaluated the effects of outpatient cost-sharing on health care utilization by the aged. Cost sharing of the elderly had little effect on controlling health care utilization.

The Effects of Case Management for Medicaid on Healthcare Utilization by the Medicaid System

PURPOSE: This study examined the effects of case management (CM) for Medicaid on healthcare utilization considering the Medicaid system. METHODS: Data were extracted from survey data on "Healthcare utilization and health status of Medicaid beneficiaries" conducted in 2007 and 2008 by the Ministry for Health, Welfare and Family Affairs. This study was designed to compare the effects on healthcare utilization between the CM group and the non-CM group. The subjects were 535 Type I Medicaid beneficiaries who utilized healthcare more than 365 days during 2006. RESULTS: The outpatient days and medication days of the CM group decreased significantly more than those of the non-CM group with the copayment system. There were no significant differences of healthcare utilization between the CM group and the non-CM group with the designated doctor system. CONCLUSION: CM worked effectively on Medicaid beneficiaries' outpatient healthcare utilization with the copayment system. However, its effects on hospitalization, which is a major cause increasing the total expense, were not observed. Therefore, future studies are needed to develop strategies to reduce hospitalization and Medicaid beneficiaries' outpatient healthcare utilization with the designated doctor system.

The Effect of the Cost Exemption Policy for Hospitalized Children under 6 Years Old on the Medical Utilization in Korea / 예방의학회지

OBJECTIVES: The Korean government in January 2006 instigated an exemption policy for hospitalized children under the age of six years old. This study examines how this policy affected the utilization of medical care in Korea. METHODS: A total of 1,513,797 claim records from the Health Insurance Review Agency were analyzed by complete enumeration methods. The changes of medical utilization were compared from 2005 to 2006. In addition, the changes of medical utilization between 2004 and 2005 were compared as a pseudocontrol group. RESULTS: The admission rate increased 1.14-fold from 15.20% in 2004 to 17.32% in 2005, and this further increased 1.08-fold to 18.65% in 2006. The increase of patients with a common cold (1.2-fold) was higher than that of both the general patients (1.08-fold) and the patients with the top 10 fatal diseases (0.91-fold). The average length of stay per case for clinics showed the highest increase rates (1.06-fold). The rates of patients with the common cold showed a higher increase (1.05-fold) than that of the general patients. The average medical expense per case was increased by 1.10-fold from 2005 to 2006, which was higher than that from 2004 to 2005 (1.04-fold). The increase rate for patients with the common cold was higher at 1.18-fold than that of the general patients. CONCLUSIONS: The cost exemption policy has especially led to an increase in the utilization of clinics and the utilization by patients with a common cold.