Impact of User Fees in Health Care System on Health Care Consumption

Abstract

Abstract:In comparison to other European countries, it is claimed that the Czech Republic belongs to the countries with higher health care consumption, even if health status does not positively correlate with health care use. Therefore, user fees as a form of patient cost sharing were introduced to regulate health care consumption and to confront the patient with resource scarcity in the health care system as a part of health care reform package in 2008. The goal of the paper is to determine the changes in health care consumption after user fees implementation and evaluate their regulatory effect in a short period of time. The analysis of the changes in health care consumption is made on the basis of data from the largest health insurance company -VZP ČR (60 % of the Czech population). The health care consumption is monitored according to particular types of health care services for particular age groups in years 2007, 2008 and 2009. This analysis identifies the major changes in the consumption after user fees implementation among the observed age groups of Czech population. Furthermore, it is possible to prove the regulatory effect of user fees in a short period of time (2 years).

The Barriers To Implementation Of New Public Management Strategies In Iran’s Primary Health Care: A Qualitative Study

“…As an instance, Italy implemented contracting out in health care but lack of strategic planning and restricted efficiency gains through high transaction costs led to decrease in access and no change in efficiency 54 . It is reported that lack of effective patient charters and complaints system and informal payments had a negative effect on access and efficiency in Czech Republic, Russia, Ukraine, and Armenia health care system 55,56 . In public health complexes, managers and employees don't have a competitive view.…”

Market-Type Mechanisms and Public Service Equity: A Review of Experiences in European Public Services

“…Examples of other market-type mechanisms in the dataset include user choice mechanisms and user charges in healthcare in the Czech Republic, Estonia and Hungary (Atun et al 2006;Krutilová 2010;Nagyistók 2010) liberalization and privatization across the EU and market-type mechanisms more generally (Audit Commission, 2002;Nemec and Kolisnichenko 2006). Unlike the studies on contracting out and quasi-market arrangements, where evidence on deteriorated public service equity was minimal, 50% of the cases of other market-type mechanisms documented some evidence on decreased equity (Table 7).…”

“…A possible explanation for this observation is that unlike other forms of market-type mechanisms, which concern how a public service is provided and by whom, user charges and user choice are more closely related to access to services. For example, the introduction of user charges (co-payments) in primary healthcare in Czech Republic led to a decrease in the use of some services (Krutilová 2010). A 26% drop was documented in primary home care visits compared to ordinary consultations, and a significant decrease in the use of medication (30.17% in 2008 and 27.65% in 2009).…”

“Doctor my eyes”: A natural experiment on the demand for eye care services

“…by increasing the price paid by the individual at the time of consumption. The overwhelming majority of studies conducted in developed countries conclude that cost-sharing reduces demand for preventive services (Christensen, 1995;Friedman et al, 2002;Kiefe et al, 1994;Krůtilová, 2010;Lundberg et al,1998;Nexøe et al, 1997;Solanki et al, 2000;Stoner et al,1998). Similarly, for studies conducted in low-and middle-income countries (LMICs), the evidence suggests that the introduction or increase in user fees has almost and everywhere led to a decrease in utilisation (Schokkaert and Van de Voorde, 2011;Cohn and Dupas, 2010;Borghi et al, 2006;Souteyrand et al, 2008) Economic theory further predicts that cost-sharing generates adverse distributional consequences as low income individuals reduce utilisation more than the remaining population.…”