Utilization Of Public Services Research Articles

Effectiveness of the health and wellness centers in improving identification and primary care of non-communicable diseases in Chhattisgarh State of India

ABSTRACT Introduction: India launched a national initiative named Health and Wellness Centres (HWCs) in 2018 to provide population-based primary care including for the non-communicable diseases (NCDs) in rural areas. The current study assesses whether operationalization of HWCs improved the detection of NCDs and increased the share of public sector facilities in providing NCD services. Methods: Two rounds of household surveys were conducted in rural Chhattisgarh in 2019 and 2022. With a focus on NCDs, the household survey covered a representative sample of individuals above the age of 30 years – 2760 individuals in 2019 and 2638 in 2022. Multi-variate regression analysis was carried out to determine effects of HWCs on identification of NCDs and utilization of public sector services. Results: The population covered by HWCs had 25% greater chance of being identified with NCDs as compared to the population without HWCs (AOR = 1.25, P = 0.03). The NCD patients living in areas covered by HWCs had 70% greater chance of utilizing the public healthcare facilities (AOR = 1.70, P = 0.01). In the population covered by HWCs, the share of the public sector in NCD care increased from 41.2% in 2019 to 62.1% in 2022, whereas the share of informal private providers dropped from 23.5% in 2019 to 8.4% in 2022. Conclusion: The HWCs showed effectiveness in increasing detection of NCDs at the population level and bringing a larger share of NCD patients to utilize public sector services. They can prove to be a crucial architectural correction for improving primary care service delivery for NCDs and other population health needs in India.

How COVID-19 has changed the utilization of different health care services in Poland

BackgroundThe COVID-19 pandemic has affected health care systems in many ways, including access to and the use of non-COVID services. The aim of the study was to assess the impact of the pandemic on the utilization of different public health care services in Poland.MethodsThe aggregated data on health care users and provided services for the years 2015/2016–2021 were used to analyse the changes in health care utilization during the pandemic and deviations from pre-pandemic utilization trends. Quantitative analysis was complemented with qualitative descriptions of the changes in principles of health care provision during the pandemic.ResultsThe results show a considerable drop in the provision of most health care services in 2020 that in some cases disturbed pre-pandemic utilization trends and was not made up for in 2021. The most significant decrease has been observed in the field of preventive and public health services, as well as rehabilitation. The provision of these services was put on hold during the pandemic.ConclusionsThe accumulated COVID-19-related “health debt” urgently calls for government actions to strengthen disease prevention and health promotion in Poland.

Intervention efficacy of combined urban community public services and duloxetine in persons with anxiety disorders

BackgroundAnxiety disorders have become a major public health problem in urban communities. To address this issue, this study proposes the hypothesis that by combining community public services and duloxetine treatment, the symptoms of residents diagnosed with anxiety disorder can be improved. This study aims to explore a novel intervention that combines community public services with duloxetine therapy. Community public services can provide a range of support and resources, including psychological counseling, social support, and life skills training. Duloxetine, a commonly used anti-anxiety drug, is widely used in the treatment of anxiety disorders.Subjects and MethodsThis non-randomized control study involved urban residents diagnosed with anxiety disorders. We used the Stanford Acute Stress Response Questionnaire (SASRQ) and the 3-min Confusion Assessment Scale (3D-CAM) as our primary assessment tools. Data were collected and statistically analyzed using SPSS23.0 software.ResultsFollowing targeted community interventions supplemented with Duloxetine treatment, the affected residents exhibited a significant decrease in SASRQ and 3D-CAM scores, representing a reduction in anxiety symptoms. Moreover, improved community involvement and increased utilization of public services were noted post-intervention.ConclusionsThe application of urban community public services combined with Duloxetine appears to effectively alleviate anxiety symptoms among city residents. It not only enhances mental well-being but also bolsters community cohesion and public service utilization. Despite the promising results showcasing this concerted approach’s potential, more extensive research is crucial to unequivocally substantiate and refine this intervention strategy.AcknowledgementSuqian Branch of the Grand Canal Cultural Belt Construction Institute 2022 general project (No. dyhsq202206).

Explaining public dental service utilization: A theoretical model.

Constructing and validating a theoretical model of relationships between dental services use and socioeconomic characteristics, oral health status, primary care coverage, and public dental services. The first stage of the study consisted of developing a theoretical-conceptual model to demonstrate the expected relationships between variables based on the literature. In the second stage, we tested the proposed theoretical model using the Partial Least Squares Structural Equation Modeling (PLS-SEM) technique, using data from the Brazilian National Health Survey conducted in 2019 with a sample of 41,664 individuals aged 15 or older. This study successfully defined a theoretical model that explains the systematic relationships involving public dental services utilization. Socioeconomic status was negatively associated with oral health status (β = -0.376), enrollment in primary care facilities (β = -0.254), and the use of public dental consultations (β = -0.251). Being black, indigenous, or living in a rural area was directly associated with lower socioeconomic status and greater use of public dental services. The identified relationships, establishing a theoretical basis for further investigations, also provide evidence of a public access policy's effect on oral health services on equity, supporting the construction of more effective and equitable public policies.

Equality of public health service and family doctor contract service utilisation among migrants in China

China initiated the equalisation of an essential public health service programme in 2009 with the goal of developing a more equitable and effective public health system for all people. This study employs data from the China Migrants Dynamic Survey to examine regional-level and household-level income-related inequalities in public health service utilisation and its determinants. Wagstaff concentration indices indicate that essential public health services and family doctor contract services are concentrated among less developed prefectures and poorer households. Decomposition analysis based on recentered influence function regression shows that education contributes to pro-poor inequality in health records and health education utilisation. China's policies of essential public health services and family doctor contract services reduce income-related inequalities in health service utilisation, which has important implications for developing countries striving to achieve universal health service coverage and equal health outcomes.

Patterns and predictors of public dental service utilisation among refugees in Victoria, Australia: a latent profile and multilevel analysis

BackgroundThe purpose of the study was to explore, analyse, and describe the patterns of public dental service utilisation among the refugee populations in Victoria, Australia, and determine their predictors at the individual and contextual levels.MethodsData on the refugees who attended Victorian public dental services between July 2016 to June 2020 was gathered from the Dental Health Program dataset. Latent profile analysis was used to identify discrete groups among the refugee clientele with similar mean utilisation patterns across six indicator variables describing the attributes of dental services received and the site of care provision, over the study period. Multilevel multinomial logistic regression analysis was performed to examine the individual and contextual level correlates of the identified utilisation patterns.ResultsSix distinct profiles of public dental service utilisation were identified among the study population (n = 25,542). The largest group comprised refugees predominantly using restorative services under general course of care (38.10%), followed by extraction services under emergency course of care (23.50%). Only a small proportion were estimated as having a higher mean utilisation of preventive services under general course of care (9.10%). Multilevel analysis revealed that the following variables had a significant association with refugee utilisation pattern: at the individual-level – demographic and ethnic attributes including age, gender, region of birth, preferred language for communication, use of language interpreter services, and type of eligibility card; at the contextual-level – characteristics of refugees’ neighbourhood of residence including urbanicity, socioeconomic disadvantage, delivery of Refugee Health Program at the community health centres, and spatial accessibility to public dental services via driving and public transit modes of travel.ConclusionsThe study represents a significant step towards the development of an evidence-based knowledge around public dental service utilisation among Victorian refugees. Overall, the study findings reiterate the critical need for targeted strategies to promote the importance of routine dental visits, oral disease prevention, and timely intervention among refugee groups.

Factors associated with the use of public eHealth services in Poland - a 2022 nationwide cross-sectional survey.

Poland is an example of a European country that has made significant progress in digitizing healthcare during the last 5 years. There is limited data on the use of eHealth services by different socio-economic groups in Poland during the COVID-19 pandemic The aim of the study was to characterize public attitudes towards the use of e-Health services in Poland, as well as to identify factors associated with the use of e-Health services among adults in Poland. A questionnaire-based survey was carried out during 9-12 September 2022. A computer-assisted web interview methodology was used. A nationwide random quota sample of 1,092 adult Poles was selected. Questions on the use of 6 different public eHealth services in Poland and soci-economic characteristics were addressed. Two-thirds of participants (67.1%) had received an e-prescription in the last 12 months. More than half of the participants used the Internet Patient Account (58.2%) or the patient.gov.pl website (54.9%). One-third of the participants had teleconsultation with a doctor (34.4%), and approximately one-quarter of participants had received electronic sick leave (26.9%) or used electronic information about treatment dates (26.7%). Of the ten different socio-economic factors analyzed in this study, educational level, and place of residence (p<0.05) were the most important factors associated with the use of public eHealth services among adults in Poland. Living in rural areas or small cities is associated with a lower level of public eHealth services utilization. A relatively high interest in health education through eHealth methods was observed.

Analisis Pengaruh Kualitas Website Kejaksaan Negeri Penajam Paser Utara Menggunakan Metode Webqual

The information technology that used by the Penajam Paser Utara Regency of Prosecuting Attorney Office is a website to support information and public services is more easily, on the website there are several news` menus, profiles, vision and mission, and several of public services. The main function of the Penajam Paser Utara regency of Prosecuting Attorney website as an online public service facility. So far the Penajam Paser Utara Regency prosecuting Attorney has paid little attention to their website and there has no progress because the Penajam Paser Utara Regency of Prosecuting Attorney has no permanent staff in the Information Technology section .The purpose of this research is to know how the quality of the Penajam Paser Utara Regency Prosecuting Attorney Office website affects To The user satisfaction based on the WebQual 4.0 method. The results of the Research for usability quality (X1), it can be seen that the significance value of the usability quality (X1) is 0.035 &lt; 0.05 or T count 2.143) &gt; T table (1.995) so H1 is accepted, then there is an influence between the usability quality (X1) with the user satisfaction (Y). Meanwhile, for Information Quality (X2), it can be seen that the significant value of the information quality (X2) is 0.064 &gt; 0.05 or T count (-1.878) &lt; T table (1.995) so H2 is rejected, so there is no influence between the information quality (X2) with the satisfaction user (Y). As for the Quality of Interaction (X3), it can be seen that the significance value of the quality of the interaction (X3) is 0.002 &lt;0.05 or T count (3.184) &gt; T table (1.995) so H3 is accepted, then there is an influence between the quality of the interaction (X3) with The user satisfaction (Y). From The results obtained are expected to be the recommendation for the Penajam Paser Utara regency Prosecuting attorney Office to develop a much higher quality of the website, So as to increase the utilization of public services through the Penajam Paser Utara regency Prosecuting Attorney Office website, besides that it is also suggested for the future that the Penajam Paser Utara regency prosecuting Attorney Office is given the attention to the overall of quality of the Penajam Paser Utara Regency Prosecuting Attorney Office website in order to maintain or to increase of the user satisfaction in using their website

Being Insider-Outsider: Public Policy, Social Identity, and Delivery of Healthcare Services in India

Abstract&#x0D; The pivotal role of community level workers in the delivery of public services is well-recognized. But, they often fail to provide equal opportunities to all ‘eligible’ beneficiaries to utilize a variety of public services. Although several predisposing household factors are held responsible for inequalities in access to the public services, in recent times, one factor that has been recognised as critical to such unequal access to public services is the ‘exclusionary nature of social relations’ based on social identity embedded in the social life of village community. It is also argued that certain sections of the population are deprived of equal access to public services due to their social identity, which is different from service providers. However, the question remains–whether it is the social identity of users or providers of public services that is critical to unequal access to various services? What will be the extent of utilization of public services when the social identity of both users and providers of the services remain same? Do the social dynamics of the community life play any role in the delivery of public services? This essay addresses these questions in the context of delivery of integrated nutrition and healthcare services at the community level under the largest national flagship scheme of Integrated Child Development Services (ICDS). Drawing evidence from a larger sample survey of over 4000 household beneficiaries and 200 service providers, the essay sheds light on how the delivery of healthcare services is fraught with social injustice due to dominant socio-cultural norms around social identity despite the values of healthcare centres to cater to the health needs of all sections of society.

Accessibility of Public Healthcare Facilities and Their Distribution in Benin City, Edo State

Access to quality health services determines human health and well-being, especially in this pandemic era. The objective of the study is to examine the factors that affect the utilization and accessibility of public healthcare services within selected local government areas in Benin City. The study adopted the use of 400 questionnaires, which were administered to respondents within the study area. ArcGIS 10 was used to depict health facility disparities within the city, while Pearson’s Product Moment Correlation was used to test healthcare utilization. The results indicate that public healthcare facilities are clustered in distribution, having a 0.28 nearest neighbour ratio. The public healthcare facilities are accessible and there are no shortages of healthcare within the study area. Socio-demographic variables such as gender, age, marital status, education, and employment at a were positively related to healthcare accessibility. Approximately 73% of patronage and the type of public healthcare facility influence facility utilization in the study area. Factors influencing accessibility and utilization of healthcare facilities are means of transportation, travel distance, and challenges within healthcare facilities. The quality of services at 48% improves healthcare utilization. This study recommends that health care facilities need to be maintained to encourage more patronage and better service delivery that includes a policy framework for the regular maintenance and provision of necessary equipment and infrastructure that would encourage accessibility and utilization of public healthcare facilities.

Assessing spatial–temporal evolution and key factors of urban livability in arid zone: The case study of the Loess Plateau, China

Urban livability (UL) plays an important direction of sustainable cities and society. According to the core connotation of urban sustainable development goals (SDGs), this study deconstructed the relationship between UL and SDGs, and extracted corresponding indicators to construct a universal and scientific evaluation index system for evaluating urban livability in arid zone. The UL system was divided into seven dimensions: economic growth, urban construction and population, urban public service capacity, resource consumption and utilization, living standard of residents, current situation of urban environment, environmental pollution. TOPSIS model and SYS-GMM model were adopted to explore the spatial–temporal evolution and key factors of urban livability in arid areas, 24 cities on the Loess Plateau from 2013 to 2018 were chosen for this study. The evaluation results indicate that the overall livable level of 24 cities is not ideal, the temporal characteristic shows a rising trend of fluctuation, and the spatial characteristic shows central depression. Additionally, the empirical results show that there are six key factors for urban livability in the Loess Plateau, the fixed asset investment and population density have a negative impact on UL, while environmental regulation, industrial structure optimization, income level and Institutional quality play a positive impact on UL. The UL index system can measure the UL situation comprehensively and scientifically, which can provide a universal applicability index system for ecologically sensitive & arid areas to research UL, construct ecological livable cities, and achieve SDGs.

An 11-year longitudinal analysis of refracture rates and public hospital service utilisation in Australia’s most populous state

SummaryThis detailed 11-year longitudinal analysis calculated the public health cost of managing refractures in people aged ≥ 50 years in Australia’s most populous state. It provides current and projected statewide health system costs associated with managing osteoporosis and provides a foundation to evaluate a novel statewide model of fracture prevention.PurposeThe purpose of this longitudinal analysis was to calculate current and projected refracture rates and associated public hospital utilisation and costs in New South Wales (NSW), Australia. These results will be used to inform scaled implementation and evaluation of a statewide Osteoporotic Refracture Prevention (ORP) model of care.MethodsLinked administrative data (inpatient admissions, outpatient attendances, Emergency Department presentations, deaths, cost) were used to calculate annual refracture rates and refracture-related service utilisation between 2007 and 2018 and healthcare costs between 2008 and 2019. Projections for the next decade were made using ‘business-as-usual’ modelling.ResultsBetween 2007 and 2018, 388,743 people aged ≥ 50 years experienced an index fracture and 81,601 had a refracture. Refracture was more common in older people (rising from a cumulative refracture rate at 5 years of 14% in those aged 50–64 years, to 44% in those aged > 90 years), women with a major index fracture (5-year cumulative refracture rate of 26% in females, compared to 19% for males) or minimal trauma index fracture and those with an osteoporosis diagnosis (5-year cumulative refracture rate of 36% and 22%, respectively in those with and without an osteoporosis diagnosis). Refractures increased from 8774 in 2008 to 14,323 in 2018. The annual cost of refracture to NSW Health increased from AU$130 million in 2009 to AU$194 million in 2019. It is projected that, over the next decade, if nothing changes, 292,537 refracture-related hospital admissions and Emergency Department presentations and 570,000 outpatient attendances will occur, at an estimated total cost to NSW Health of AU$2.4 billion.ConclusionThis analysis provides a detailed picture of refractures and associated projected service utilisation and costs over the next decade in Australia’s most populous state. Understanding the burden of refracture provides a foundation for evaluation of a novel statewide ORP model of care to prevent refractures in people aged ≥ 50 years.

Public Private Partnerships in Indian Railways

Indian Railways, since its inception have been under government ownership. But with increasing demand and cost pressures, entry of private sector has become inevitable. Indian railways have also embraced the idea of use of public private partnership for better public service and efficient resource utilization. This paper studies the effectiveness of using public private partnership (PPP) model in Indian railways. The public-private partnership model for investment, though a phenomenal success in case of roadways, or in other words, highway development projects, has till now failed in making any significant impact in the railway sector Well aware of the importance of PPPs in economic development, the railways had initiated several concrete measures to explore the PPP route for improving its flagging infrastructure across the country. But the private sector's response to these initiatives, however, has been somewhat subdued. The paper studies the various PPP projects which IR has undertaken, and which are in the pipeline for the future, their success rate, the factors which are acting as enablers, and more importantly, the factors, which are responsible for lower success rate of PPP model in Indian Railways. It tries to explore the opportunities and potential hidden in using PPP model for Indian railways.

Assessment and key factors of urban liveability in underdeveloped regions: A case study of the Loess Plateau, China

Urban liveability is an important index to measure the sustainable development of urban socioeconomic. Based on the deconstruction of urban sustainable development goals (SDGs), a new-comprehensive and scientific evaluation index system was constructed to evaluate the urban liveability of underdeveloped regions, entropy weight TOPSIS model and Tobit model were used to investigate the urban liveability and key factors in underdeveloped regions. The evaluation index system was divided into seven aspects in this study, involving economic development, urban construction, public service, social progress, living standard, ecological environment, and resource utilization. To explore the key factors of urban liveability and the application of the index system in underdeveloped regions, the Loess Plateau was chosen for this investigation. The empirical results indicates that there are six significant key factors affecting urban liveability in the Loess Plateau. Among them, urbanization rate, natural population growth rate, and population density play a negative role in urban liveability. For another, per capita local fiscal revenue, per capita green area, and GDP growth rate play a positive role in urban liveability. The index system can evaluate the urban liveability scientifically of underdeveloped regions, it can be used for Livable city construction for other underdeveloped regions or developing countries.

Urban rural differentials in spatial distribution of pregnant women's choice of delivery place by district in Punjab - Results from Pakistan Social and Living Standards Measurements Survey 2014-15.

Madam, home deliveries are fraught with higher risks of maternal and neonatal complications, but in many developing countries childbearing women choose to deliver at home.1-3 Utilization of public or private maternal healthcare services is predicated on availability of, access to, and cost concerns. Public sector healthcare facilities are designed to essentially provide free services.1-3 In this study, percent of delivery sites utilization, disaggregated by urban and rural residency status in each district of the Punjab province were mapped using Geographic information Systems. The spatial distribution of delivery site percentages, disaggregated by three places of either home delivery, delivery at government facilities (hospital, Rural Health Center, and Basic Health Units), and delivery at private hospitals or clinics was done to highlight the urban and rural distribution, including the differences between urban and rural percentages. &#x0D; Continues...

Differentials in private and public healthcare service utilization in later life: do gender and marital status have any association?

ABSTRACT The present study investigates whether the differentials in private and public inpatient healthcare utilization are associated with marital status for men and women aged 60 years and above in India. Binary logistic regression was applied to examine the association of private and public inpatient healthcare utilization with the marital status of the elderly. The study found that widowed men and women generally used public healthcare for hospitalization, while married men and women preferred private healthcare. Our findings also indicated that private inpatient health services expenditure was higher for married elderly than widowed elderly. After controlling all covariates, widowhood was significantly associated with higher use of public healthcare services for women but not for men. India’s current health care policy and program may be required to focus on improving the infrastructure quality of current public healthcare systems. It also needs to be favorable for vulnerable sections of society, especially widowed women, to avail better treatment at an affordable cost.

Understanding women's provider choice for induced abortion in Turkey

In Turkey, women gained free access to induced abortion from public facilities through the legalization of abortion in 1983. However, due to unmet need and abortion stigma, women use predominantly private services. The political discourse on anti-abortion in the past decade has triggered a diminishing trend in public provision. This runs against both the 1983 Law and the healthcare reforms initiated in 2003, which aimed at universal access to health services. This study investigates the socioeconomic characteristics of women affecting the utilization of public services for induced abortion. Using “Turkey Demographic and Health Survey 2013”, the results of Probit models indicate that women who were young, unmarried, wealthier and whose abortion decisions were made by themselves or their spouses were less likely to choose the public services for induced abortion. Regional differences in the utilization of public sector were also observed. Findings indicate a need to ensure and widen women's access to abortion nationwide; both at the hospital and outpatient level. Health education programs including family planning should give special emphasis to young, single and socioeconomically disadvantaged women who are more prone to apply for unsafe abortion when access to public and/or private sector is limited. A transparent referral system should be designed to timely direct women to abortion services.

Essential public healthcare services utilization and excess non-COVID-19 mortality in Greece

ObjectivesEnsuring access to care for all patients—especially those with life-threatening and chronic conditions—during a pandemic is a challenge for all healthcare systems. During the COVID-19 pandemic, many countries faced excess mortality partly attributed to disruptions in essential healthcare services provision. This study aims to estimate the utilization of public primary care and hospital services during the COVID-19 epidemic in Greece and its potential association with excess non-COVID-19 mortality in the country. Study designThis is an observational study. MethodsA retrospective analysis of national secondary utilization and mortality data from multiple official sources, covering the first nine months of the COVID-19 epidemic in Greece (February 26th to November 30th, 2020), was carried out. ResultsUtilization rates of all public healthcare services during the first nine months of the epidemic dropped significantly compared to the average utilization rates of the 2017–19 control period; hospital admissions, hospital surgical procedures, and primary care visits dropped by 17.3% (95% CI: 6.6%–28.0%), 23.1% (95% CI: 7.3%–38.9%), and 24.8% (95% CI: 13.3%–36.3%) respectively. This underutilization of essential public services—mainly due to supply restrictions such as suspension of outpatient care and cancelation of elective surgeries—is most probably related to the 3778 excess non-COVID-19 deaths (representing 62% of all-cause excess deaths) that have been reported during the first 9 months of the epidemic in the country. ConclusionsGreece's healthcare system, deeply wounded by the 2008–18 recession and austerity, was ill-resourced to cope with the challenges of the COVID-19 epidemic. Early and prolonged lockdowns have kept COVID-19 infections and deaths at relatively low levels. However, this “success” seems to have been accomplished at the expense of non-COVID-19 patients. It is important to acknowledge the “hidden epidemic” of unmet non-COVID-19 needs and increased non-COVID-19 deaths in the country and urgently strengthen public healthcare services to address it.

Contextual and individual factors associated with public dental services utilisation in Brazil: A multilevel analysis.

This study verified the association between contextual and individual factors and public dental services utilisation in Brazil. The study was conducted based on a cross-sectional population-based household survey performed in Brazil (National Health Survey- 2019)). Data was collected between August 2019 and March 2020. Total sample included 43,167 individuals aged ≥15 years who had at least one dental appointment in the last 12 months before interview. Study outcome was 'public dental service utilisation', and Andersen's behavioral model was adopted for selecting independent variables. A multilevel analysis was performed using individual factors as first level and federation units as second level. The highest prevalence of public dental service utilisation on an individual level was observed among unable to read or write people (PR: 3.31; p<0.001), indigenous (PR: 1.40; p<0.001), black or brown (PR: 1.16; p<0.001), with per capita household income of up to U$124 (PR: 2.40; p<0.001), living in the rural area (PR: 1.28; p<0.001), and who self-rated oral health as regular (PR: 1.15; p<0.001) or very bad/bad (PR: 1.26; p<0.001). On the contextual level, highest PR of public dental service utilisation was observed among those living in federal units with increased oral health coverage in primary health care. Public dental service utilisation is associated with individual and contextual factors. These results can guide decision-making based on evidence from policymakers, demonstrating the potential for mitigating oral health inequalities and increasing service coverage in a public and universal health system.

Long-term effectiveness of elderly health care voucher scheme strategies: a system dynamics simulation analysis

BackgroundThe elderly healthcare voucher (EHCV) scheme is expected to lead to an increase in the number of elderly people selecting private primary healthcare services and reduce reliance on the public sector in Hong Kong. However, studies thus far have reported that this scheme has not received satisfactory responses. In this study, we examined changes in the ratio of visits between public and private doctors in primary care (to measure reliance on the public sector) for different strategic scenarios in the EHCV scheme.MethodsBased on comments from an expert panel, a system dynamics model was formulated to simulate the impact of various enhanced strategies in the scheme: increasing voucher amounts, lowering the age eligibility, and designating vouchers for chronic conditions follow-up. Data and statistics for the model calibration were collected from various sources.ResultsThe simulation results show that the current EHCV scheme is unable to reduce the utilization of public healthcare services, as well as the ratio of visits between public and private primary care among the local aging population. When comparing three different tested scenarios, even if the increase in the annual voucher amount could be maintained at the current pace or the age eligibility can be lowered to include those aged 60 years, the impact on shifts from public-to-private utilization were insignificant. The public-to-private ratio could only be marginally reduced from 0.74 to 0.64 in the first several years. Nevertheless, introducing a chronic disease-oriented voucher could result in a significant drop of 0.50 in the public-to-private ratio during the early implementation phase. However, the effect could not be maintained for an extended period.ConclusionsOur findings will assist officials in improving the design of the EHCV scheme, within the wider context of promoting primary care among the elderly. We suggest that an additional chronic disease-oriented voucher can serve as an alternative strategy. The scheme must be redesigned to address more specific objectives or provide a separate voucher that promotes under-utilized healthcare services (e.g., preventive care), instead of services designed for unspecified reasons, which may lead to concerns regarding exploitation.