ABSTRACT
Background@#As the Philippines moves toward universal health coverage, it is imperative to examine how to eliminate inefficiencies, particularly misuse, overutilization, and risks of fraudulent claims. This position statement aimed to identify health services requiring copayments for cost-efficient health financing for the Universal Health Care Act. @*Methods@#A qualitative study was employed using a systematic review of literature, and thematic analysis of policy roundtable discussion (RTD) was conducted. The systematic review of literature generated evidence for the policy brief and critical points for discussion in the stakeholders’ RTD forum. The RTD was organized by the UP Manila Health Policy Development Hub (UPM HPDH) with the Department of Health (DOH) and was participated by key stakeholders of the policy issue to attain consensus recommendations and develop criteria for identifying services requiring copayments. @*Results@#An algorithm is proposed by the UPM HPDH based on collective expertise as a guide for policymakers to assess each benefit package in terms of overutilization, the danger of depleting government funds, and the risk of fraud. The use of clinical pathways is suggested to assess the misuse and overutilization of health services. In addition to copayments, benefits packages prone to fraudulent activities should be subjected to fraud prevention processes. Copayment should be linked inversely to the preventability level of the disease or condition. @*Conclusion@#There were gaps in the current policies to identify services requiring copayment services. Copayment schemes should be carefully determined to prevent misuse, overuse, and fraud of appropriate and necessary health services, while at the same time not limit access to needed care.
Subject(s)
Universal Health Insurance , Cost Sharing , Medical OveruseABSTRACT
PURPOSE: The incidence of colorectal cancer in Korea has recently increased, making it the second most common cancer in men and the third most common cancer in women. Risk factors for colorectal cancer have been studied worldwide, but risk factors specific for the Korean population have not been established. In this study, we investigated incidence trends and risk factors of colorectal cancer in Korea.METHODS: A total of 8,846,749 subjects were included. Colorectal cancer incidence was investigated using Korea National Health Insurance Service claim data from 2004 to 2014. Colorectal cancer diagnoses were obtained by evaluating colorectal cancer diagnostic codes and the cancer registry for cost sharing. Risk factor identification for colorectal cancer was obtained from National Health Examination data from 2004 to 2005. Cox proportional hazard model statistical analysis was used to determine risk factors of colorectal cancer.RESULTS: The incidence of colorectal cancer gradually increased from 2006 to 2014 (from 45.4/100,000 to 54.5/100,000). There was a predominance among men (1.47:1), but incidence trends were similar in both sexes. Old age, high body mass index, and no history of colonoscopy were identified as risk factors in both sexes. High fasting blood glucose, familial history of cancer, frequent alcohol intake, and current smoker were identified as risk factors, especially in men.CONCLUSION: The incidence of colorectal cancer has been increasing in Korea. Colonoscopy screening was a protective factor for colorectal cancer, and active use of colonoscopy may reduce incidence. Early diagnosis and care are important, particularly for the high-risk group.
Subject(s)
Female , Humans , Male , Blood Glucose , Body Mass Index , Cohort Studies , Colonoscopy , Colorectal Neoplasms , Cost Sharing , Diagnosis , Early Diagnosis , Fasting , Incidence , Korea , Mass Screening , National Health Programs , Population Characteristics , Proportional Hazards Models , Protective Factors , Retrospective Studies , Risk FactorsABSTRACT
Abstract This paper aims to analyse changes in the retail pharmaceutical market following policy changes in the Farmácia Popular Program (FP), a medicines subsidy program in Brazil. The retrospective longitudinal analyses focus on therapeutic class of agents acting on the renin-angiotensin system. Data obtained from QuintilesIMS (formerly IMS Health) included private retail pharmacy sales volume (pharmaceutical units) and sales values from 2002 to 2013. Analyses evaluated changes in market share following key FP policy changes. The therapeutic class was selected due to its relevance to hypertension treatment. Market share was analysed by therapeutic sub-classes and by individual company. Losartan as a single product accounted for the highest market share among angiotensin II antagonists. National companies had higher sales volume during the study period, while multinational companies had higher sales value. Changes in pharmaceutical market share coincided with the inclusion of specific products in the list of medicines covered by FP and with increases in or exemption from patient copayment.
Resumo Este artigo visa analisar as mudanças no mercado de varejo farmacêutico, seguindo as alterações de diretiva no Programa Farmácia Popular (FP), que realiza subvenção de medicamentos no Brasil, em parceria pública privada. Foi realizada análise longitudinal retrospectiva dos medicamentos da classe terapêutica dos agentes que atuam sobre o sistema renina-angiotensina. Os dados obtidos do QuintilesIMS incluíram o varejo farmacêutico em termos do volume e valores de vendas de 2002 a 2013. Análises realizadas consideraram intervenções e reformas ocorridas no FP e seu impacto no mercado farmacêutico da classe terapêutica selecionada, devido a sua relevância para o tratamento da hipertensão. Também se examinou o comportamento do mercado tomando por base as empresas farmacêuticas produtoras. Losartan monodroga representou a maior fatia de mercado entre os antagonistas de angiotensina II. Empresas nacionais obtiveram maior volume de vendas durante o período de estudo, enquanto as empresas multinacionais exibiram maior valor de vendas. Mudanças no mercado farmacêutico coincidiram com a inclusão de produtos específicos na lista de medicamentos abrangidos pelo FP e com aumentos ou isenção de copagamento pelos pacientes.
Subject(s)
Humans , Commerce/statistics & numerical data , Angiotensin II Type 1 Receptor Blockers/therapeutic use , Drug Industry/economics , Antihypertensive Agents/therapeutic use , Renin-Angiotensin System/drug effects , Brazil , Retrospective Studies , Longitudinal Studies , Cost Sharing/economics , Losartan/economics , Losartan/therapeutic use , Angiotensin II Type 1 Receptor Blockers/economics , Interrupted Time Series Analysis , Health Policy , Hypertension/drug therapy , Antihypertensive Agents/economics , Antihypertensive Agents/pharmacologyABSTRACT
ABSTRACT OBJECTIVE To assess the distribution of financial burden in Chile, with a focus on the burden and progressivity of out-of-pocket payment. METHODS Based on the principle of ability to pay, we explore factors that contribute to inequities in the health system finance and issues about the burden of out-of-pocket payment, as well as the progressivity and redistributive effect of out-of-pocket payment in Chile. Our analysis is based on data from the 2006 National Survey on Satisfaction and Out-of-Pocket Payments. RESULTS Results from this study indicate evidence of inequity, in spite of the progressivity of the healthcare system. Our analysis also identifies relevant policy variables such as education, insurance system, and method of payment that should be taken into consideration in the ongoing debates and research in improving the Chilean system. CONCLUSIONS In order to reduce the detected disparities among income groups, healthcare priorities should target low-income groups. Furthermore, policies should explore changes in the access to education and its impact on equity.
Subject(s)
Humans , Delivery of Health Care/economics , Financing, Personal/economics , Health Expenditures/statistics & numerical data , Healthcare Disparities/economics , Chile , Cost Sharing , Delivery of Health Care/statistics & numerical data , Financing, Personal/statistics & numerical data , Healthcare Disparities/statistics & numerical dataABSTRACT
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.
Subject(s)
Humans , Cost Sharing , Delivery of Health Care , Early Detection of Cancer , Health Behavior , Health Care Costs , Health Expenditures , Korea , Medicaid , Medication Adherence , National Health Programs , Outpatients , Quality of Life , Statistics as Topic , Surveys and QuestionnairesABSTRACT
The four goals of good healthcare are to relieve symptoms, cure disease, prolong life and improve quality of life. Access to healthcare has been a perpetual challenge to healthcare providers who must take into account important factors such as equity, efficiency and effectiveness in designing healthcare systems to meet the four goals of good healthcare. The underlying philosophy may designate health as being a basic human right, an investment, a commodity to be bought and sold, a political demand or an expenditure. The design, policies and operational arrangements will usually reflect which of the above philosophies underpin the healthcare system, and consequently, access. Mechanisms for funding include fee-for-service, cost sharing (insurance, either private or government sponsored) free-of-fee at point of delivery (payments being made through general taxes, health levies, etc) or cost-recovery. For each of these methods of financial access to healthcare services, there are ethical issues which can compromise the four principles of ethical practices in healthcare, viz beneficence, non-maleficence, autonomy and justice (1, 2). In times of economic recession, providing adequate healthcare will require governments, with support from external agencies, to focus on poverty reduction strategies through provision of preventive services such as immunization and nutrition, delivered at primary care facilities. To maximize the effect of such policies, it will be necessary to integrate policies to fashion an intersectoral approach.
Las cuatro metas de la buena atención de la salud son: aliviar los síntomas, curar la enfermedad, prolongar la vida, y mejorar la calidad de vida. El acceso a la atención a la salud ha sido un desafío perenne para los proveedores de atención a la salud, quienes tienen que tener en cuenta factores importantes tales como la equidad, la eficacia y la efectividad a la hora de diseñar sistemas de atención a la salud que permitan alcanzar las cuatro metas de la buena atención a la salud enumeradas arriba. La filosofía subyacente podría definir la salud como un derecho humano básico, una inversión, un artículo que puede ser comprado y vendido, una demanda política o un gasto. El diseño, las políticas y las disposiciones operacionales normalmente dirán cuales de estas filosofías anteriores sirve de base al sistema de atención a la salud, y por consiguiente, al acceso. Los mecanismos para el financiamiento incluyen el pago por servicio, costos compartidos (seguro, privado o patrocinado por el gobierno) libre de pago a la hora del servicio (pagos que se hacen a través de los impuestos generales, impuestos de salud, etc.) o recuperación de costos. Para cada uno de estos métodos de acceso financiero a la atención a la salud, hay problemas éticos que pueden comprometer los cuatro principios de la práctica ética de la atención a la salud, a saber, la beneficencia, la no maleficencia, la autonomía y la justicia (1, 2). En tiempos de recesión económica, brindar atención adecuada a la salud requiere que los gobiernos - con apoyo de agencias exteriores - pongan su mira en las estrategias para reducir la pobreza, ofreciendo servicios preventivos - tales como la inmunización y la nutrición - en los centros de atención primaria. Para maximizar el efecto de tales políticas, será necesario integrar las políticas con una perspectiva intersectorial.
Subject(s)
Humans , Bioethical Issues , Health Services Accessibility/economics , Health Services Accessibility , Cost Sharing , Economic Recession , Financing, Organized , Human RightsABSTRACT
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.
Subject(s)
Aged , Humans , Middle Aged , Age Factors , Cost Sharing/economics , Health Services/economics , Insurance Claim Review , Office Visits/economicsABSTRACT
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.
Subject(s)
Humans , Case Management , Cost Sharing , Delivery of Health Care , Hospitalization , Medicaid , OutpatientsABSTRACT
OBJECTIVES: This study aimed to determine the magnitude of the barriers to the practice of Atraumatic Restorative Treatment (ART) as perceived by dental practitioners working in pilot dental clinics, and determine the influence of these barriers on the practice of ART. MATERIAL AND METHODS: A validated and tested questionnaire on barriers that may hinder the practice of ART was administered to 20 practitioners working in 13 pilot clinics. Factor analysis was performed to generate barrier factors. These were patient load, management support, cost sharing, ART skills and operator opinion. The pilot clinics kept records of teeth extracted; teeth restored by conventional approach and teeth restored by ART approach. These treatment records were used to compute the percentage of ART restorations to total teeth treated, percentage of ART restorations to total teeth restored and percentage of total restorations to total teeth treated. The mean barrier scores were generated and compared to independent variables, using the t-test. The influence of barriers to ART-related dependent variables was determined using Pearson correlation coefficients. RESULTS: Mean barrier values were low, indicating low influence on ART practice. Female practitioners had higher scores on patient load than male practitioners (p = 0.003). Assistant Dental Officers had higher scores on cost sharing than Dental Therapists (p = 0.024). Practitioners working in urban clinics had higher mean scores on patient load than those who worked in rural clinics (p = 0.0008). All barrier factors were negatively correlated with ART practice indices but all had insignificant association with ART practice indices. CONCLUSION: The barriers studied were of low magnitude, with no significant impact on practice of ART in dental clinics in the pilot area.
Subject(s)
Female , Humans , Male , Attitude of Health Personnel , Dental Atraumatic Restorative Treatment , Dental Clinics , Dentists/psychology , Health Services Accessibility , State Dentistry , Clinical Competence , Cost Sharing , Dental Records , Dental Atraumatic Restorative Treatment/economics , Dental Atraumatic Restorative Treatment/statistics & numerical data , Dental Auxiliaries/psychology , Dental Clinics/organization & administration , Dental Restoration, Permanent/statistics & numerical data , Pilot Projects , Practice Management, Dental , Patients/statistics & numerical data , Rural Health Services/statistics & numerical data , Surveys and Questionnaires , Tanzania , Tooth Extraction/statistics & numerical data , Urban Health Services/statistics & numerical data , WorkloadABSTRACT
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.
Subject(s)
Child, Preschool , Humans , Cost Sharing/legislation & jurisprudence , Health Policy , Health Services/statistics & numerical data , Hospitalization , Insurance Claim Review , Korea , Length of StayABSTRACT
During the past fifteen years, the government of Sudan introduced a number of initiatives to finance heath care in general, and essential medicines in particular, as part of health reform. The lack of evidence-based policymaking means that the government subjectively changes health care financing policies frequently. It is clear that the intent of the government has been to increase equity of access to health services of acceptable quality. The evaluation study conducted by Mohamed [1] represents the first empirical evidence of the impact of Cost-Sharing Policy [CSP], in general, and Revolving Drug Fund [RDF], in particular, on the accessibility to essential medicines and thereby the utilization of public health facilities. In this article, the health financing mechanisms adopted and the future of the CSP will be discussed
Subject(s)
Health Care Costs , Cost Sharing , Insurance, HealthSubject(s)
Cost Sharing , Fees and Charges , Health Care Reform , National Health Programs , Vulnerable PopulationsABSTRACT
OBJECTIVE: The purpose of this study was to compare the hospital stay and cost-effectiveness between treatment modalities in ectopic pregnancy for proper management. METHODS: In this study, the authors studied 121 cases retrospectively who had been admitted and treated at Department of Obstetrics and Gynecology, Konyang University Hospital from February 1, 2000 to August 31, 2003. We analyzed clinical features, treatment modality, hospital stay and cost-effectiveness between each groups. One-way ANOVA test was used and p<0.05 was regarded as statistically significant. RESULTS: There was no difference in clinical features between treatment modalites. Of total 121 cases, operative procedures were done in 105 cases (explo-laparotomy in 58, laparoscopy in 43, dilatation and curettage in 4) and medical treatment in 16 cases (Multiple dose methotrexate protocol in 11, Single dose methotrexate protocol in 5). Average of length of hospital stay was 5.3 +/- 0.2 days in explo-laparotomy, 3.8 +/- 0.2 days in laparoscopy, 2.8 +/- 1.4 days in dilatation and curettage, 6.5 +/- 0.5 days in multiple dose methotrexate protocol, 2.4 +/- 0.4 days in single dose methotrexate protocol. According to treatment modality, there was significant difference in total cost and cost sharing. Total cost in explo-laparotomy (875,324 +/- 25,977 Won) was more expensive than that of laparoscopy (734,375 +/- 35,179 Won). But, cost sharing in explo-laparotomy (156,543 +/- 9,583 Won) was less expensive than laparoscopy (319,493 +/- 26,255 Won). Total cost and cost sharing in multiple dose methotrexate protocol (323,231 +/- 33,972 Won, 184,465 +/- 17,344 Won) was more expensive than that of Single methotrexate protocol (192,495 +/- 31,180 Won, 68,793 +/- 13,422 Won). CONCLUSION: Based on these results, it is very important that we should have an interest in ectopic pregnancy for early detection and proper management. Consequently, Achievement of precise decision and successful methotrexate treatment can be possible to decrease hospital stay and cost-effectiveness.
Subject(s)
Female , Pregnancy , Cost Sharing , Dilatation and Curettage , Gynecology , Laparoscopy , Length of Stay , Methotrexate , Obstetrics , Pregnancy, Ectopic , Retrospective Studies , Surgical Procedures, OperativeABSTRACT
Since the 1950s, China has had a very wide coverage of healthcare service at the local level. In urban areas, the employment-based healthcare-insurance schemes (Government Insurance Scheme and Labour Insurance Scheme) worked hand in hand with the full employment policy of the Government, which guaranteed basic care for almost every urban resident. However, since the economic reforms of the early 1980s, China's healthcare system has met great challenges. Some came from the reform of the labour system, and other challenges came from the introduction of market forces in the healthcare sector. The new policy of the Chinese Government on the Urban Employees' Basic Health Care Insurance is to introduce a cost-sharing plan in urban China. Like other major social policy changes, this new health policy also has a great impact on the lives of the Chinese people. Affordability has been the major concern among urban residents. Shanghai implemented the cost-sharing healthcare policy in the spring of 2001. It may be too early to assess the pros and cons of the new policy, but evidence shows that the employment-based health-insurance scheme excludes those at high risk and in most need. It is argued that the cost-sharing healthcare system will limit access by some people, especially those who are most vulnerable to the consequences of ill health and those in low-income groups, unless the deductibles vary according to income and unless low-income groups are exempt from paying premiums and deductibles.
Subject(s)
Adult , Age Factors , Aged , China , Cost Sharing/statistics & numerical data , Cost of Illness , Health Benefit Plans, Employee/economics , Health Care Reform/economics , Health Care Sector , Health Transition , Humans , Middle Aged , Socioeconomic Factors , Urban HealthABSTRACT
The question of willingness to pay is very crucial in planning for services. In Pakistan, the long-term issues of sustainability of health systems particularly, allocation of finances have routinely been addressed by planners with insufficient data and unclear goals. This study was conducted with the objectives to determine the demand for health care services in the community; at first level care facilities and community level and determine the willingness of the community [Willingness to pay] to participate in cost sharing mechanisms for provision of primary health care in fee for service and prepayment mechanisms. A cross sectional stratified household interview survey of 600 households was carried out in urban and rural areas of district Jehlum, to address the financial sustainability of government health care interventions at the community level and to explore the question of willingness to pay for health care and their ability to participate in the cost sharing mechanisms. In response to willingness to pay at a Government facility to obtain health care 437 [72.7%] of the households expressed their willingness to pay for health care. In 72% of the cases, cost was not considered as a barrier in seeking care and only 19% of the cases considered cost as a partial barrier; the rest said that cost prohibited seeking care. A majority across all strata is willing to pay for consultation and medicines at public sector facilities, although the responses from the low income groups exhibit a slight decrease in the willingness to pay. The willingness to pay is marginally affected by income, place of residence and/or cost of the treatment incurred. The findings of this study suggest that the community is willing to pay for health care at the public sector facilities if payment can ensure provision of essential curative services and medications at improved quality levels
Subject(s)
Health Care Costs , Health Services Needs and Demand , Cost SharingABSTRACT
In an attempt to evaluate the feasibility of local anesthesia [infiltration] as an alternative to general anesthesia in hemorrhoidectomy to estimate the cost-effectiveness. Two groups of patients had the same surgical procedure [hemorrhoidectomy]. One group received local [n = 36] and the second received general anesthesia [n = 20]. Both groups were subjected to the same evaluation as far as perioperative monitoring, evaluation and procedure success. Any postoperative pain was scored using a visual analog scale [VAS] in the first three postoperative days. All patients were evaluated at two weeks and two months postoperatively. The cost of the operative procedure for both groups was compared and documented. Apart from one patient from group B who developed sinus tachycardia prior to surgery and opted to have the procedure performed under local anesthesia rather than re-schedule, both groups had successful surgical procedures with no observed difference in the outcome
Subject(s)
Humans , Male , Female , Ambulatory Surgical Procedures , Anesthesia, Local/methods , Cost Sharing , Length of StayABSTRACT
BACKGROUND: Family doctor registration program was proposed several years ago and is still in discussion. The success of this program depends on attitude and acceptability of people. This study was done to describe the attitudes of the people to the family doctor registration program. METHODS: We interviewed 657 adults who lived in Seoul, Bundang, llsan and Pyungchon with a preformed questionnaire. The questionnaire was pretested by five family doctors and trainee. RESULTS: About half of the respondents were favorable for family doctor registration program. The most importantly considered benefits of the program were continuity of care, telephone consultation and management of chronic disease. The most seriously considered drawbacks of the program were only single doctor available cost, and restriction of medical services. Over half of the respondents preferred internists as their treating doctor and family physician, pediatrician followed. About half of the respondents opposed on the fact that the family doctor was restricted to clinic-based practice. Half of the respondents intended to Participate in the program and the rate of intention to participate in the family doctor registration program was related to their household income and favorable attitude to wards the program and marginally related to the number in a household, haring a regular doctor, their interest in health. The demographie variables did not influence intention to participate in the program. CONCLUSIONS: Half of the respondents agreed to participate in the family doctor registration program, but ethers were negative to the principles of the program and cost sharing.
Subject(s)
Adult , Humans , Chronic Disease , Continuity of Patient Care , Cost Sharing , Surveys and Questionnaires , Ether , Ethers , Family Characteristics , Family Practice , Hares , Intention , Korea , Physicians, Family , Seoul , TelephoneABSTRACT
Presenta estudio los efectos de capitalización sobre condiciones de trabajo médico y sobre la estructura de mercado de las empresas medicas previsionales (EMP) en Nicaragua. Muestra estadísticas de los beneficiados por el seguro social desde 1978 al 1998. La información esta organizada en 6 secciones: sección 2 presenta el estudio de los objetivos; sección 3 contiene información de antecedentes sobre el sector salud de Nicaragua; sección 4 ofrece un marco teórico sobre los efectos de capitalización sobre la hipótesis que se formula por los resultados esperados de la reforma del seguro social; la sección 5 describe los métodos del estudio; sección 6 estudia los resultados y las sección final ofrece conclusiones sobre el estudio