The impact of change from copayment to coinsurance on medical care usage and expenditure in outpatient setting in older Koreans

Abstract

Patient cost-sharing change was implemented on August 1, 2007, for outpatient care in the clinic setting in Korea from copayment to coinsurance. This study aims to estimate the effect of the policy change on medical care usage and expenditure in older Koreans. By using national health insurance claims data from the Health Insurance Reimbursement Assessment Service, this study analyzed the entire 137 million claims for a total of approximately 4.1 million patients aged 60 to 69 years who had been diagnosed and/or treated for outpatient care in clinics from January 1, 2007, to December 31, 2008. Medical care usage was defined as the proportion of all beneficiaries in each group who visited clinics and the mean number of visit days per beneficiary. Medical care expenditure per visit day was expressed as total costs, reimbursed amount, and patient's out-of-pocket payment. Data on January through June of 2008 were analyzed as compared with the same months of 2007. Raw difference-in-difference and multiple regression analyses were performed. The interaction coefficients, which measured the impact of cost-sharing change, was -0.078 in model 1 and -0.039 in model 2 (P < .0001). In conclusion, a cost-sharing change from copayment to coinsurance reduced medical care usage and expenditure.

Trends in polypharmacy over 12 years and changes in its social gradients in South Korea

“…In 2012–2013, after the change to the coinsurance system, decreased health care utilization among the most affluent patients may have influenced the relatively higher health care utilization in the most deprived group, resulting in an increased OR. Our interpretation is in line with a previous finding that medical care utilization, defined as the proportion of all beneficiaries in each group who visited clinics and the mean number of visit days per beneficiary, decreased after the cost-sharing change to coinsurance in South Korea [ 41 ]. Moreover, medical accessibility for the most deprived participants was enhanced by the coverage expansion of the Medical Aid Program to patients with rare, intractable, and chronic diseases, as well as children under the age of 18 in 2004 [ 44 ].…”

“…In order to reduce the burden of rapidly increasing health expenditures after the initiation of the National Health Insurance program in 1989 [ 40 ], a patient cost-sharing change was implemented for outpatients aged younger than 65 years on August 1, 2007. In the copayment system, outpatients had a fixed medical expense of KRW (Korean won) 3,000 from their own money unless the total costs exceeded the threshold of KRW 15,000; if the total costs were greater than the threshold, patients were obligated to pay 30% [ 41 ]. After the coinsurance policy was implemented, national health beneficiaries (1st decile–10th decile) shared 30% of the total costs from their own money, regardless of total costs [ 42 ], whereas the copayment system was still applied to medical aid patients.…”

Age Structural Transitions and Copayment Policy Effectiveness: Evidence from Taiwan’s National Health Insurance System

“…Another strand of the literature, on the effect of user fee (consisting of copayment and cost-sharing) changes on healthcare utilization, applied a difference-in-differences (DID) regression model to evaluate the effect of user fees on the utilization of various healthcare services. In general, a negative association between user fees and healthcare utilization was found for inpatient care services [13][14][15], outpatient care services [14,[16][17][18][19][20][21][22], long-term care utilization [23,24], psychiatric care services [25,26], rehabilitation care services [27] and prescription drug usage [28][29][30].…”

“…In addition to hospitals, local clinics in Taiwan are built to deal with primary care. Over 80% of children (age < 15) receive their outpatient care from the local clinics, and the elderly (aged 65 and older) and youth (aged [15][16][17][18][19][20][21][22][23][24] contribute the largest (approximately 36.88-38.90%) and smallest shares (approximately 3.03-3.83%) of total outpatient care visits, respectively, to medical centers, regional hospitals, and district hospitals [2,5]. It is important to note that the reimbursement payments per outpatient visit to district hospitals (NT$ 1770 or about USD 59), regional hospitals (NT$ 2445 or about USD 82) and medical centers (NT$ 3261 or about USD 109) were 2.37-4.36 times higher than those made to local clinics (NT$ 748 or about USD 25) in 2016 [2].…”

Factors Associated with Willingness to Pay for Cost-Sharing under Universal Health Coverage Scheme in Yogyakarta, Indonesia: A Cross-Sectional Survey

“…A questionnaire on the willingness to pay for cost-sharing under the NHI scheme was used to determine the demographic status that affected the health expenditure patterns of the population, in Yogyakarta, such as health-seeking behavior, the characteristics and patterns of health expenses, and the willingness to pay for cost-sharing under the NHI scheme. Age, income, level of education, family size, chronic diseases, healthcare needs, types of insurance, utilization of healthcare, types of healthcare facility, awareness of schemes, medical history, and wealth are factors that affect willingness to pay or out-of-pocket expenses, as shown in several studies [ 3 , 24 , 25 ].…”