Expanding health insurance to increase health care utilization: Will it have different effects in rural vs. urban areas?

Erlyana, Erlyana; Damrongplasit, Kannika; Melnick, Glenn

doi:10.1016/j.healthpol.2010.11.008

Cited by 31 publications

(33 citation statements)

References 17 publications

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“…Nevertheless, our results are roughly comparable with those found for example by Erlyana et al . () from cross‐sectional survey data in Indonesia.…”

Section: Discussionmentioning

confidence: 99%

“…Several empirical studies suggest that geographical accessibility to health care positively affects the use of health services and health outcomes (Campbell et al, 2000;Erlyana et al, 2011;Haynes and Bentham, 1982;Hyndman et al, 2000;Lavy and Germain, 1994;Pathman et al, 2006). They are mainly based on crosssectional variation in accessibility (an exception is Avdic, 2014), that is, they compare the behaviour of population closer to the health service provider with those farther from it, controlling for healthcare needs (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Effects of Geographical Accessibility on the Use of Outpatient Care Services: Quasi‐Experimental Evidence from Panel Count Data

2015

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In 2010-2012 new outpatient service locations were established in Hungarian micro-regions, which had lacked such capacities before. We exploit this quasi-experiment to estimate the effect of geographical accessibility on outpatient case numbers using both individual-level and semi-aggregate panel data. We find a 24-27 per cent increase of case numbers as a result of the establishments. Our specialty-by-specialty estimates imply that a one-minute reduction of travel time to the nearest outpatient unit increases case numbers e.g. by 0.9 per cent in internal care and 3.1 per cent in rheumatology. The size of the new outpatient capacities has a separate effect, raising the possibility of the presence of supplier-induced demand.By combining a fixed-effects logit and a fixed-effects truncated Poisson estimator, we decompose the effects into increases in the probability of ever visiting a doctor on the one hand and an increase of the frequency of visits on the other. We find that new visits were dominant in the vast majority of specialties, whereas both margins were important e.g. in rheumatology. Finally, we demonstrate the usefulness of the fixed-effects truncated Poisson estimator in modelling count data by examining its robustness by simulations.3

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“…Nevertheless, our results are roughly comparable with those found for example by Erlyana et al . () from cross‐sectional survey data in Indonesia.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of Geographical Accessibility on the Use of Outpatient Care Services: Quasi‐Experimental Evidence from Panel Count Data

2015

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“…The available beds are poorly utilized with an average occupancy rate of 60 percent [2]. The reasons for low availability of beds, yet low occupancy of beds, includes low health budget from the government and financial, geographical and cultural barriers [3], and also the perception of low quality health services by the community [4]. As secondary or tertiary health care facilities, these hospitals receive medical cases referred by public health centers or medical practitioners from sub-district and community levels.…”

Section: Introductionmentioning

confidence: 99%

Priorities and realities: addressing the rich-poor gaps in health status and service access in Indonesia

Utomo

Sucahya

Utami

2011

International Journal for Equity in Health

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IntroductionOver the past four decades, the Indonesian health care system has greatly expanded and the health of Indonesian people has improved although the rich-poor gap in health status and service access remains an issue. The government has been trying to address these gaps and intensify efforts to improve the health of the poor following the economic crisis in 1998.MethodsThis paper examines trends and levels in socio-economic inequity of health and identifies critical factors constraining efforts to improve the health of the poor. Quantitative data were taken from the Indonesian Demographic Health Surveys and the National Socio-Economic Surveys, and qualitative data were obtained from interviews with individuals and groups representing relevant stakeholders.ResultsThe health of the population has improved as indicated by child mortality decline and the increase in community access to health services. However, the continuing prevalence of malnourished children and the persisting socio-economic inequity of health suggest that efforts to improve the health of the poor have not yet been effective. Factors identified at institution and policy levels that have constrained improvements in health care access and outcomes for the poor include: the high cost of electing formal governance leaders; confused leadership roles in the health sector; lack of health inequity indicators; the generally weak capacity in the health care system, especially in planning and budgeting; and the leakage and limited coverage of programs for the poor.ConclusionsDespite the government's efforts to improve the health of the poor, the rich-poor gap in health status and service access continues. Factors at institutional and policy levels are critical in contributing to the lack of efficiency and effectiveness for health programs that address the poor.

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“…Health care continues to remain a vital public health focus, with the emphasis on improving quality of care while reducing health care costs 1,2. This approach leads to a potential quandary for the practicing clinician because costs of care (new imaging technologies, expanding therapeutic armamentariums) continue to increase, while reimbursements (optical coherence tomography [OCT] imaging, intravitreal injections) continue to decline 3.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of economic efficiencies in clinical retina practice: activity-based cost analysis and modeling to determine impacts of changes in patient management

Murray¹,

Tornambe²,

Tong³

2011

OPTH

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BackgroundThe purpose of this study is to report the use of activity-based cost analysis to identify areas of practice efficiencies and inefficiencies within a large academic retinal center and a small single-specialty group. This analysis establishes a framework for evaluating rapidly shifting clinical practices (anti-vascular endothelial growth factor therapy, microincisional vitrectomy surgery) and incorporating changing reimbursements for care delivery (intravitreal injections, optical coherence tomography [OCT]) to determine the impact on practice profitability. Pro forma modeling targeted the impact of declining reimbursement for OCT imaging and intravitreal injection using a strategy that incorporates activity-based cost analysis into a direct evaluation schema for clinical operations management.MethodsActivity-based costing analyses were performed at two different types of retinal practices in the US, ie, a small single-specialty group practice and an academic hospital-based practice (Bascom Palmer Eye Institute). Retrospective claims data were utilized to identify all procedures performed and billed, submitted charges, allowed charges, and net collections from each of these two practices for the calendar years 2005–2006 and 2007–2008. A pro forma analysis utilizing current reimbursement profiles was performed to determine the impact of altered reimbursement on practice profitability. All analyses were performed by a third party consulting firm.ResultsThe small single-specialty group practice outperformed the academic hospital-based practice on almost all markers of efficiency. In the academic hospital-based practice, only four service lines were profitable, ie, nonlaser surgery, laser surgery, non-OCT diagnostics, and injections. Profit margin varied from 62% for nonlaser surgery to 1% for intravitreal injections. Largest negative profit contributions were associated with office visits and OCT imaging.ConclusionActivity-based cost analysis is a powerful tool to evaluate retinal practice efficiencies. These two distinct practices were able to provide significant increases in clinical care (office visits, ophthalmic imaging, and patient procedures) through maintaining efficiencies of care. Pro forma analysis of 2011 data noted that OCT payments to facilities and physicians continue to decrease dramatically and that this payment decrease further reduced the profitability for the two largest aspects of these retinal practices, ie, intravitreal injections and OCT retinal imaging. Ultimately, all retinal practices are at risk for significant shifts in financial health related to rapidly evolving changes in patterns of care and reimbursement associated with providing outstanding clinical care.

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Expanding health insurance to increase health care utilization: Will it have different effects in rural vs. urban areas?

Cited by 31 publications

References 17 publications

Effects of Geographical Accessibility on the Use of Outpatient Care Services: Quasi‐Experimental Evidence from Panel Count Data

Effects of Geographical Accessibility on the Use of Outpatient Care Services: Quasi‐Experimental Evidence from Panel Count Data

Priorities and realities: addressing the rich-poor gaps in health status and service access in Indonesia

Evaluation of economic efficiencies in clinical retina practice: activity-based cost analysis and modeling to determine impacts of changes in patient management

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