Copayment Scheme Research Articles

Optimizing chronic healthcare payment scheme: integrating patient effort in service pricing for enhanced self-management performance

PurposeThe study aims to address a critical gap in existing healthcare payment schemes and care service pricing by recognizing the influential role of patients' decisions on self-management efforts. These decisions not only impact health outcomes but also shape the demand for care, subsequently influencing care costs. Despite the significance of this interplay, current payment schemes often overlook these dynamics. The research focuses on investigating the implications of a novel behavior-based payment scheme, designed to align incentives and establish a direct connection between patients' decisions and care costs. The primary objective is to comprehensively understand whether and how this innovative payment scheme structure influences key stakeholders, including patients, care providers, insurers and overall social welfare.Design/methodology/approachIn this paper, we propose a game-theoretical model to incorporate the performance of self-management with the demand for healthcare service, compare the patient's effort decision for self-management and provider's price decision for healthcare service under a behavior-based scheme with that under two implemented widely payment schemes, that is, co-payment scheme and co-insurance scheme.FindingsOur findings confirm that the behavior-based scheme incentives patient self-management more than current schemes while reducing their possibility of seeking healthcare service, which indirectly induces the provider to lower the price of the service. The stakeholders' utility under various payment schemes is sensitive to the cost of treatment and the perceived health utility of patients. Especially, patient health awareness is not always benefited provider profit, as it motivates patient self-management while diminishing the demand for care.Originality/valueWe provide a novel framework for characterizing behavior-based payment schemes. Our results confirm the need for modification of the current payment scheme to incentivize patient self-management.

Promoting habitual mobile payment usage via the Thai government's 50:50 co-payment scheme

The Thai government launched an economic stimulus initiative using mobile payments (m-payments) to alleviate the economic and public health effects of the COVID-19 outbreak. The advantages of this program and the simplicity, dependability, and contact-free nature of m-payments have led to its widespread adoption in Thailand. Many Thai individuals have never used the m-payment method before. Hence, the aim of this study was to investigate at potential factors that encourage frequent m-payment usage with an emphasis on user attitudes and continual usage intentions. The technology acceptance model and the mental accounting theory were used in this study to analyse 506 respondents who had completed a questionnaire survey. According to the structural equation modeling analysis of the survey data, Thai peoples' desire to take part in the government's co-payment program is most influenced by enjoyment, financial benefits, ease of use, health benefits, and situational factors. Surveyed participants particularly liked utilizing m-payment to benefit from the 50% rebate on full-priced goods and services. It was found that a positive attitude toward m-payment use alone is insufficient to promote long-term adoption of contactless payment technology. However, prolonged reliance on the m-payment system was shown to increase the likelihood of habitual usage.

The influences of Experienced Life Events (Project from governmental) Focused on Anxiety and Perceived Risk toward the Continuance Intention to Use Online Banking of customers

At present, market researchers realize importance of experienced life events affecting consumers' behavior. The experienced life events are influenced by things around each consumer leading to different behavior (Elder, 1998 ;Moschis, 2007), which can positively and negatively affect experience life events (Drake, Sheffield, & Shingler, 2011). However, essential experienced life events may play a role in consumers' behavior leading to the increasing number of online banking service users in Thailand. Positive life events may play a crucial role in the consumers' behavior to increasingly use online banking services such as projects of the government (Half-half Co-payment Scheme). There were 23.94 million users with total spending of 62,966.6 million Baht. 33.2 million. For Wewin Project (Roa Chana), 33.2 persons were eligible, and total spending was 266,612 million (Bangkok Biz, 2022). However, Thailand just started developing to be a cashless society with swift good change. Online banking service is an innovative financial technology that changes ways of living and behaviors of consumers to access banks more quickly and conveniently. However, according to the previous studies regarding consumers' behavior, a number of people found the online banking service impractical, and the key obstacle was that the consumers were anxious and scared, and perceived risks and unsafety that may happen from such kind of service (Plainbangyang, Siriwat, 2018 ;Panyalimpanun, Thitipol, 2017) Perceived risks and anxiety are contrary to current phenomenon. Statistically, the number of online banking users in past 5 years in Thailand from June 2017- June 2021, tremendously increased from 45,167,588 accounts to 110,839,744 accounts (Bank of Thailand, 2021). Such phenomenon happened during crucial experienced life events which may affect intention of using online banking services of the consumers apart from anxiety and fear from online banking services. Keywords: Perceived risk, Anxiety, Online Banking, Experience Life Events.

Does the abolition of copayment increase ambulatory care utilization?: a quasi-experimental study in Germany.

Due to a problematic situation with public finances, Germany introduced a copayment scheme for ambulatory care visits in 2004. In 2012, Germany achieved a balanced budget, and copayment was abolished on the 1st of January 2013. This policy change offers a rare opportunity to explore the impact of the abolition of copayment, compared to the much more frequently studied introduction of copayment. We therefore investigate the development of ambulatory care and inpatient care utilization following this policy change among people over 50 in Germany, as well as the heterogeneous impacts among vulnerable people, such as the low-income population, the chronically ill and the elderly over the age of 65. We use data from the Survey of Health, Ageing and Retirement in Europe and adopt a difference-in-differences approach with matching. We found that the abolition of copayment only caused an increase in ambulatory care use in the shorter term, while leading to a significant reduction in the longer term. In addition, we find a negative effect on inpatient care use, i.e., the hospitalization offset effect. Finally, we demonstrate that vulnerable people were more sensitive to the abolition of copayment.

Copayment policy reforms and effective care utilization by patients with persistent asthma in Taiwan

ObjectivesReforms to the Taiwan National Health Insurance copayment scheme in 2005 imposed a notable increase in the cost of outpatient visits. This provided an ideal situation to determine whether such reforms lead to a reduction in the utilization of effective care by patients with persistent asthma. MethodsThis study applied the pretest-posttest non-randomized control group design in our analysis of nationwide claims data (2002 to 2010). Based on propensity score matching, the patients were divided into two groups, subject and not subject to copayment reform. Medication Management for People with Asthma measure was used to identify patients with persistent asthma and instances of effective care. ResultsMatching yielded a final panel of 7,890 individuals with persistent asthma (3,945 individuals in each cohort) eligible for the study. GEE analysis revealed that policy reforms had significant effects over the short-term (OR = 0.745, p < 0.05), medium-term (OR = 0.752, p < 0.01), and long-term (OR = 0.721, p < 0.01). ConclusionsReforms to copayment policy were significantly correlated with a reduction in the utilization of effective care by patients with persistent asthma over the short-, medium- and long-term. Government should develop implementation strategies aimed at protecting the economically disadvantaged patients.

Effect of an outpatient copayment scheme on health outcomes of hypertensive adults in a community-managed population in Xinjiang, China.

Hypertension remains the leading risk factor for death and disability in China, and the ability of hypertensive patients to pay for outpatient care and medication has become a critical issue. To report the effect of an outpatient copayment scheme on health outcomes of hypertensive adults in a community-managed population in Xinjiang, we compared changes in outcomes between insured and uninsured groups from baseline to the first follow-up appointment in a community-managed hypertensive population and evaluated these changes based on propensity score matching and the difference-in-difference method. A total of 1,095 individuals in a community-managed hypertension population were selected for investigation at baseline, among which 805 (73.5%) had follow-up data and 749 (68.4%) were included in our analysis. After accounting for the self-reported severity of hypertension and individual characteristics, there were statistically significant improvements in drug treatment of hypertension and self-reported health. We also found increases in drug treatment for hypertension between groups, after correcting for confounding variables (Odds Ratio, OR 8.05, 95% Confidence interval, CI, 1.31–49.35), and in self-reported health between groups after correcting confounders (OR 1.96, 95% CI, 1.12 to 3.42). Adjusted estimates (confounding variables) were corrected for age, sex, income, marital status, education level, employment, family size, self-reported severity of hypertension, course of hypertension, and number of medications. As a result, decreased outpatient copayment was associated with an increase in antihypertensive treatment coverage, and an improvement in self-reported health among community-managed hypertensive populations in Xinjiang, China.

The impact of copayments on mental healthcare utilization: a natural experiment

Empirical evidence suggests that people are fairly sensitive to cost sharing arrangements in ambulatory mental healthcare. However, pure cost sharing effects are typically hard to measure due to the presence of adverse selection effects. In this paper, we examine the impact of cost sharing on mental healthcare utilization in the context of mandatory health insurance where adverse selection is absent. Using a large proprietary dataset of a Dutch private health insurer, we examine to what extent a new copayment scheme for adult mental healthcare changed healthcare utilization. We exploit the fact that non-adults are exempted from copayments. First, we compare changes in utilization among adults and non-adults using t tests and a difference-in-difference analysis. Second, we highlight differential changes in mental healthcare utilization by treatment (duration and type of mental illness) and individual characteristics (gender and socioeconomic status). Third, we evaluate to what extent anticipatory behavior occurred pending the introduction and subsequent repeal of the new copayment scheme. Our results show a strong and significant (p < 0.01) decrease in outpatient secondary mental healthcare utilization among adults following the introduction of copayments, which is absent among non-adults. This decrease is concentrated among treatments for less severe mental illnesses. Furthermore, the utilization patterns suggest the presence of anticipatory behavior.

Impact of co-payment for outpatient utilization among Medical Aid beneficiaries in Korea: A 5-year time series study

BackgroundThe Korean government implemented an outpatient co-payment scheme in July 2007 to control Medical-Aid beneficiaries⿿ overutilization of healthcare services. ObjectivesTo assess changes in the utilization of medical services resulting from the outpatient co-payment scheme. Methods410,142 subjects were selected and health insurance reimbursement data from July 2006 to June 2011 was examined. We assessed the changes in the total medical cost, total adjusted patient days, inpatient days, inpatient total medical cost, the number of outpatient visits, and outpatient total medical cost using segmented regression analysis. ResultsFollowing the introduction of the policy, the number of outpatient visits per person fell by 0.16 days in July 2008, and by 0.06 days in July 2010, compared to June 2007. The outpatient total medical cost per person rose by $4.11 in July 2010 compared to June 2007. The inpatient utilization increased constantly during the period of the study. So the total medical cost as well as the total adjusted number of patient days also increased constantly. ConclusionThe outpatient co-payment policy was effective for reducing the number of outpatient visits. It could not control the cost per outpatient visit and inpatient utilization. So the total medical cost was increased.

Mobilization for HIV Voluntary Counseling and Testing Services in Vietnam: Clients’ Risk Behaviors, Attitudes and Willingness to Pay

A multi-site survey was conducted on a sample of 365 clients to assess their willingness to pay for HIV voluntary counseling and testing (VCT) services in Ha Noi and Nam Dinh province, two epicenters of Vietnam. By using contingent valuation technique, the results showed that most of respondents (95.1%) were willing to pay averagely 155 (95% CI 132-177) thousands Vietnam Dong (~US $7.75, 2013) for a VCT service. Clients who were female, had middle income level, and current opioid users were willing to pay less; meanwhile clients who had university level of education were willing to pay more for a VCT service. The results highlighted the high rate of willingness to pay for the service at a high amount by VCT clients. These findings contribute to the implementation of co-payment scheme for VCT services toward the financial sustainability of HIV/AIDS programs in Vietnam.

The effect of cost-sharing in private health insurance on the utilization of health care services between private insurance purchasers and non-purchasers: a study of the Korean health panel survey (2008-2012).

BackgroundPrivate health insurance in South Korea mainly functions as supplementary and complementary health insurance that compensates for insufficient coverage by National Health Insurance. However, full private coverage of public sector cost-sharing led to the problem of encouraging moral hazard–induced utilization, resulting in a policy change that occurred in October 2009. At that time, the Korean government introduced a minimum cost-sharing policy for indemnity health insurance. The purpose of this study was to analyze the effect of cost-sharing in private health insurance on health care utilization.MethodsWe analyzed data collected from the Korean Health Panel Survey from October 2008 to December 2011. We restricted the two groups to 803 purchasers with indemnity health insurance and 7023 non-purchasers who did not obtain any private health insurance. A difference-in-difference analysis was used to evaluate the effect of the 2009 policy.ResultsAfter the policy change, the utilization of outpatient visits by purchasers gradually decreased more than non-purchasers (0.015 in 2009 [p = 0.758], −0.117 in 2010 [p < 0.016], and −0.140 in 2011 [p = 0.004]). However, utilization of inpatient services was not statistically significant. Notably, the magnitude of the cost-sharing effect in indemnity health insurance was stronger for those receiving medical aid. Among this group, utilization of outpatient services (after the policy change in 2009) decreased more so than non-purchasers. Patients with three or more chronic diseases have not changed their health care utilization.ConclusionsOur results implied meaningful lessons for decision-makers and future health insurance policies in Korea and other countries in terms of cost-sharing in medical care. When policy makers intend to implement the cost-sharing, a different copayment scheme is needed according to the socioeconomic status or disease severity.

A Copayment Auditing Scheme for Financial Misreporting

This paper proposes a copayment scheme to prevent collusion in auditing contracts, offering as a solution to financial misreporting. In the copayment scheme, both the client firm and a third party, such as PCAOB, are asked to share the auditing fee. The key feature of the copayment scheme is that the third party's expenses should be funded by the client firm. We demonstrate that the participation of a third party can create an endogenous collusion cost to the client firm, to such an extent that in the equilibrium, the client firm will not make any offer of bribery. Most importantly, the total equilibrium auditing fee is the same as in the bribery-free contract. This result makes an important contribution to the literature in addressing the issues of financial frauds and collusion between the auditor and the client firm within a principal-agent model.

PRM121 - The Impact Of The New Drug Co-Payment Scheme On Economic Evaluations In Spain

To examine the new co-payment scheme for prescribed medications introduced in Spain in 2012 and to explore differences in patient and National Health Service (NHS) drug cost co-payments between the old and the new schemes, using an example in a modelled patient population with coronary heart disease (CHD). The new legislation was researched and the new co-payment scheme was summarised in a flowchart. A published economic evaluation of drug-eluting versus bare metal stents for high-risk patients with CHD was used to calculate co-payments for the total cost of a prescribed drug (clopidogrel) from patients and from the NHS. The patient contribution was estimated from the income and expected work status of the model’s population. In the new co-payment scheme, pharmacy-dispensed drugs are divided into three categories, using the Anatomical, Therapeutic, and Chemical classification system: 1) reimbursed with reduced contribution (4.26 € per prescription in 2014), 2) reimbursed without reduced contribution (ranging from 40% to 60%, depending on declared incomes for active workers, and from 10% to 60% for retired people) and 3) not reimbursed. Monthly limits for retired people (in 2014) range from 8.26 € to 62 €, with a monthly limit of 0.426 € for long-term, chronic conditions. The current, monthly, over-the-counter price of clopidogrel is 22.92 €. Under the old co-payment scheme, the model estimated that the average NHS payment was 19.62 € per patient (86% of the cost). Under the new scheme, this amount was estimated at 16.55 € (72%). The NHS contribution decreased by 14%. The new scheme results in a significant reduction to drug-related NHS co-payment contributions. This reduction could lead to significant changes in incremental cost-effectiveness ratio estimates. It is recommended that this adjustment be made in economic evaluations developed or adapted for Spain.

The cost of antiretroviral treatment service for patients with HIV/AIDS in a central outpatient clinic in Vietnam

IntroductionAntiretroviral treatment (ART) services are estimated to account for 30% of the total resources needed for human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) control and prevention in Vietnam during the 2011–2020 timeframe. With international funding decreasing, determining the total cost of HIV/AIDS treatment is necessary in order to develop a master plan for the transition of ART services delivery and management. We analyzed the costs of HIV/AIDS treatment paid by both HIV programs and patients in a central outpatient clinic, and we explored factors associated with the capacity of patients to pay for this service.MethodsPatients (n=315) receiving ART in the Department of Infectious Diseases at Bach Mai Hospital, Hanoi, Vietnam, were interviewed. Patient records and expenses were reviewed.ResultsThe total cost of ART per patient was US$611 (75% from health care providers, 25% from patients or their families). The cost of a second-line regimen was found to be 2.7 times higher than the first-line regimen cost. Most outpatients (73.3%) were able to completely pay for all of their ART expenses. Capacity to pay for ART was influenced by five factors, including marital status, distance from house to clinic, patient’s monthly income, household economic condition, and health insurance status. Most of the patients (84.8%) would have been willing to pay for health insurance if a copayment scheme for ART were to be introduced.ConclusionThis study provides evidence on payment capacity of HIV/AIDS patients in Vietnam and supplies information on ART costs from both provider and patient perspectives. In particular, results from this study suggest that earlier access to ART after HIV infection could dramatically reduce the overall cost of treatment.

Comparing epidemiologically estimated treatment need with treatment provided in two dental schemes in Ireland

BackgroundValid estimation of dental treatment needed at population level is important for service planning. In many instances, planning is informed by survey data, which provide epidemiologically estimated need from the dental fieldworkers’ perspective. The aim of this paper is to determine the validity of this type of information for planning. A comparison of normative (epidemiologically estimated) need for selected treatments, as measured on a randomly-selected representative sample, is compared with treatment actually provided in the population from which the sample was drawn.MethodsThis paper compares dental treatment need-estimates, from a national survey, with treatment provided within two choice-of-dentist schemes: Scheme 1, a co-payment scheme for employed adults, and Scheme 2, a ‘free’ service for less-well-off adults. Epidemiologically estimated need for extractions, restorations, advanced restorations and denture treatments was recorded for a nationally representative sample in 2000/02. Treatments provided to employed and less-well-off adults were retrieved from the claims databases for both schemes. We used the chi-square test to compare proportions, and the student’s t-test to compare means between the survey and claims databases.ResultsAmong employed adults, the proportion of 35-44-year-olds whose teeth had restorations was greater than estimated as needed in the survey (55.7% vs. 36.7%;p <0.0001). Mean number of teeth extracted was less than estimated as needed among 35-44 and 65+ year-olds.Among less-well-off adults, the proportion of 16-24-year-olds who had teeth extracted was greater than estimated as needed in the survey (27.4% vs. 7.9%;p <0.0001). Mean number of restorations provided was greater than estimated as needed in the survey for 16-24-year-olds (3.0 vs. 0.9; p <0.0001) and 35-44-year-olds (2.7 vs. 1.4;p <0.01).ConclusionsSignificant differences were found between epidemiologically estimated need and treatment provided for selected treatments, which may be accounted for by measurement differences. The gap between epidemiologically estimated need and treatment provided seems to be greatest for less-well-off adults.

The effects of new pricing and copayment schemes for pharmaceuticals in South Korea

Objectives This study examined the effect of new Korean pricing and copayment schemes for pharmaceuticals (1) on per patient drug expenditure, utilisation and unit prices of overall pharmaceuticals; (2) on the utilisation of essential medications and (3) on the utilisation of less costly alternatives to the study medication. Methods Interrupted time series analysis using retrospective observational data. Results The increasing trend of per patient drug expenditure fell gradually after the introduction of a new copayment scheme. The segmented regression model suggested that per patient drug expenditure might decrease by about 12% 1 year after the copayment increase, compared with the absence of such a policy, with few changes in overall utilisation and unit prices. The level of savings was much smaller when the new price scheme was included, while the effects of a price cut were inconclusive due to the short time period before an additional policy change. Based on the segmented regression models, we estimate that the number of patients filling their antihyperlipidemics prescriptions decreased by 18% in the corresponding period. Those prescribed generic and brand-named antihyperlipidemics declined by around 16 and 19%, respectively, indicating little evidence of generic substitution resulting from the copayment increase. Few changes were found in the use of antihypertensives. Conclusions The policies under consideration appear to contain costs not by the intended mechanisms, such as substituting generics for brand name products, but by reducing patients’ access to costly therapies regardless of clinical necessity. Thus, concerns were raised about potentially compromising overall health and loss of equity in pharmaceutical utilisation.

Health disparities in medication adherence between African-Americans and Caucasians with epilepsy

ObjectiveThe goal of this study was to determine whether racial disparities exist with respect to adherence to antiepileptic drugs (AEDs) in patients with epilepsy. MethodWe reviewed the pharmacy and clinical records of 108 patients with epilepsy who were part of the indigent care program at Shands–Jacksonville. We determined the medication possession ratio (MPR) for each patient and obtained other demographic and clinical variables. Using univariate analysis we determined which variables were associated with the MPR and used multiple linear regression to determine those that best predicted the MPR. ResultsCompared with Caucasians, African-Americans had poorer (lower) MPRs (0.872 for Caucasians vs 0.796 for African-Americans, P=0.02). Age, gender, high school education, epilepsy classification, seizure freedom, number of AEDs, AED copayment scheme, and number of refills were not significantly affected by race. On stepwise multiple linear regression, race alone best predicted the MPR. ConclusionCompared with Caucasians, African-Americans have significantly poorer AED adherence, as measured by the MPR.

Quem acessa o Programa Farmácia Popular do Brasil? Aspectos do fornecimento público de medicamentos

In 2004, the Federal Government introduced the "Farmácia Popular do Brasil" Program, which was an example of policy innovation, establishing a co-payment scheme as a strategy for access to medication. The study analyzed the original model of the Program. Data were obtained from interviews with key stakeholders, program documents and user prescriptions and registers. The results showed widespread expansion of the PFPB network and in the number of people attended. Despite the ever-increasing number of people attended with prescriptions from the private sector, a large demand from public sector users, namely the original focus of the program, was observed. From the standpoint of the federative pact, the program reinstates the centralized model of essential medication distribution which, in the decentralized public system is under state and municipal responsibility. The results point to the difficulty in compliance by states and municipalities with medication distribution responsibilities, mainly in the North and Northeast regions of Brazil. The study concludes that the population has been consistently turning to the PFPB for essential medication it has not been able to access in the public sector.

Copayments for ambulatory care in Germany: a natural experiment using a difference-in-difference approach

In response to increasing health expenditures and a high number of physician visits, the German government introduced a copayment for ambulatory care in 2004 for individuals with statutory health insurance (SHI). Because persons with private insurance were exempt from the copayments, this health-care reform can be regarded as a natural experiment. We used a difference-in-difference approach to examine whether the new copayment effectively reduced the overall demand for physician visits and to explore whether it acted as a deterrent to vulnerable groups, such as those with low income or chronic conditions. We found that there was no significant reduction in the number of physician visits among SHI members compared to our control group. At the same time, we did not observe a deterrent effect among vulnerable individuals. Thus, the copayment has failed to reduce the demand for physician visits. It is likely that this result is due to the design of the copayment scheme, as the copayment is low and is paid only for the first physician visit per quarter.

Who has benefited from the health services system for the elderly in Japan?

This paper examines the demand and supply of medical services for the elderly in the health services system characterized by per-month fixed copayment and selective capitation fee scheme for outpatients with chronic diseases. The results indicate that the beneficiary, in particular the household dependent, visits a physician more frequently because the actual copayment decreases for the household dependent, but is nearly the same for the head of the household. Physicians, however, provide more services to the beneficiary partly because of the lowered copayment and partly because of the capitation fee scheme, which they will select instead of the fee-for-service scheme only when capitation is more profitable than Fee-for-Service. As a result, physicians as well as the insured benefit from the health services system.

Copayments for Ambulatory Care in Germany: A Natural Experiment Using a Difference-in-Difference Approach

In response to increasing health expenditures and a high number of physician visits, the German government introduced a copayment for ambulatory care in 2004 for individuals with statutory health insurance (SHI). Because persons with private insurance were exempt from the copayments, this health care reform can be regarded as a natural experiment. We used a difference-in-difference approach to examine whether the new copayment effectively reduced the overall demand for physician visits and to explore whether it acted as a deterrent to vulnerable groups, such as those with low income or chronic conditions. We found that there was no significant reduction in the number of physician visits among SHI members compared to our control group. At the same time, we did not observe a deterrent effect among vulnerable individuals. Thus, the copayment has failed to reduce the demand for physician visits. It is likely that this result is due to the design of the copayment scheme, as the copayment is low and is paid only for the first physician visit per quarter.