Voucher Scheme Research Articles

Barriers to preventive care utilization among Hong Kong community-dwelling older people and their views on using financial incentives to improve preventive care utilization.

BackgroundFinancial incentive is increasingly used as a mean to promote preventive care utilization (PCU), but the current Elderly Health Care Voucher Scheme (EHCVS) in Hong Kong is ineffective for encouraging PCU.ObjectiveTo explore the older people's barriers to PCU and their views on financial incentive, including EHCVS, for improving private PCU.Design and settingFocus‐group discussions were conducted in community elderly centres located in five districts of Hong Kong.ParticipantsCommunity‐dwelling older people aged 60 years or above.ResultsLack of understanding about preventive care and low awareness of the need for preventive care were key factors for the low motivation for PCU. Uncertainty over the level of service fee charged and concerns over service quality hindered the choice of using the private service providers under the current EHCVS. Financial incentives specific for preventive care services were thought to be cues to actions and guides for service promotion. However, some flexibility in service coverage and a set time limit of the financial incentives were preferred to accommodate individual needs.ConclusionsApart from promoting knowledge of preventive care, official monitoring for service fee and quality is important for empowering older people to choose private service providers for preventive care. Financial incentives for preventive care services should be more specific to cue service promotion and uptake of preventive care while maintaining flexibility to accommodate individual needs.Patient or public contributionParticipants were recruited using purposive sampling with the coordination of community elderly centres. Data were analysed using thematic coding.

The effects of the national agricultural input voucher scheme (NAIVS) on sustainable intensification of maize production in Tanzania

AbstractAfrican agricultural input subsidy programmes (ISPs) have primarily focused on conventional intensification: raising yields through increased use of inorganic fertiliser and improved seeds. Yet the yield effects from maize‐focused ISPs have been smaller than anticipated, due in part to poor maize yield response to inorganic fertiliser resulting from low soil organic matter or pH. Joint use of inorganic fertiliser with complementary soil fertility management practices—for example, organic fertiliser or maize‐legume intercropping—can contribute to more sustainable forms of agricultural intensification, while also improving yield response to inorganic fertiliser and the effectiveness of ISPs. We analyse the effects of Tanzania's ISP from 2008 to 2014, the National Agricultural Input Voucher Scheme (NAIVS), on use of these practices. Results from correlated random effects (CRE) multinomial logit (MNL) models suggest that NAIVS participation is associated with an 8–10 percentage point increase in the probabilities of inorganic fertiliser use alone and of joint use of inorganic fertiliser with organic fertiliser and/or maize‐legume intercropping on consistent maize‐growing households’ maize plots. CRE fractional MNL results suggest similar associations for the proportion of households’ total maize plots area under these practices. These results suggest that, in some cases, NAIVS may have contributed to sustainable intensification of maize production.

Evaluation of a voucher scheme to increase child physical activity in participants of a school physical activity trial in the Hunter region of Australia

BackgroundGlobal population data suggest that physical activity levels in children remain unacceptably low. Improved participation in organised sport has been recommended by the WHO as one strategy to improve population levels of physical activity. In 2018, in the state of New South Wales, Australia, the government introduced the Active Kids scheme, to help families meet the cost of getting children into organized sport. The aim of this study is to describe the uptake of Active Kids and assess the impact of the scheme on organized sport participation and child physical activity in a region of New South Wales.MethodsA pragmatic longitudinal study was undertaken of parents/carers from primary school aged children (5–12 years) in the Hunter region of NSW, Australia. Baseline data were collected between Oct-Dec 2017, with follow-up 12 months later. A telephone survey occurred at both time points, asking questions regarding registration and redemption of an Active Kids voucher for their child, child participation in organised sports and child physical activity levels.ResultsOf the 974 parents/carers who consented to participate, 511 (52.5%) completed the telephone surveys at both time points. A very large proportion of children (n = 454, 89.0%) were reported by their parents/carers at baseline as meeting the minimum physical activity guideline of 60 min per day. Of participating parents/carers in this study, 407 (96.0%) reported redeeming an Active Kids voucher. Children who redeemed a voucher had three times the odds to participate in organized team sports from baseline to follow-up (p = 0.009). Sub group analyses identified that females who redeemed a voucher had four times the odds to participate in organized team sports (p = 0.012).ConclusionsGiven the already active nature of this sample, no significant improvements in physical activity levels were noted, but the positive contribution community sport can have on health and wellbeing amongst children is reinforced. Whilst voucher schemes can address financial burdens across all socio-economic groups, more population targeting is needed to deliver voucher schemes to the most disadvantaged and inactive segments of the population in order to increase physical activity.

The Bangladesh Maternal Health Voucher Scheme: impact on completeness of antenatal care provision.

This study aimed to assess completeness of antenatal care coverage following implementation of a voucher scheme for maternal health in Bangladesh. The investigation used interview data from a survey conducted in Bangladesh in 2017 of 2400 randomly selected women aged 15-49 with children aged 0-23 months in four geographical areas where voucher scheme implementation was underway. Of these women, 1944 had attended at least one antenatal clinic visit so were included in the analysis. A 'completeness index' for antenatal visits was constructed as an outcome variable based on recall of thirteen elements of care. Bivariate analysis against independent variables of interest was carried out and multivariate linear regression models developed to examine the influence of voucher scheme participation on completeness of antenatal care adjusting for socio-demographic characteristics. Voucher scheme membership was associated with higher 'completeness index' scores, with a mean score of 185.2±101.0 for voucher recipients and 139.6 ± 93.3 for non-recipients (p<0.001). Scheme membership reduced the differentials associated with health facility type and socioeconomic status. Women from the lowest socioeconomic group who were voucher recipients received substantially more components of antenatal care (mean score: 159.6±82.1) compared with non-recipients (mean score: 115.7±83.0). This favourable effect of voucher scheme membership on the most vulnerable socioeconomic group remained significant after adjusting for educational status. The Bangladesh voucher scheme model has the potential to maximize gains in maternal and newborn health through enhancing the completeness of service provision.

Multidimensional Socioeconomic Deprivations of Maternal Health Care Services Utilisation: Evidence from Bangladesh

This paper examines the combined effect of three socioeconomic deprivations: education, wealth, and health on the utilisation of maternal health care services (MHCSs) among Bangladeshi women using the data of Bangladesh Demographic and Health Survey 2014. Both bivariate and multivariate statistical analyses were employed in this study. Multivariable logistic regression analysis is used to examine the effect of the multidimensional socioeconomic deprivations on the use of MHCSs. Of the women who had given at least one live birth in the three years preceding the survey, 43% were non-deprived by any dimension; 31% were deprived in one, 20% in two and 6% in all three dimensions. The prevalence of receiving four or more antenatal care (ANC) services was 31%; 38% used facility-based delivery (FBD) and 42% sought skilled birth assistance (SBA). When education and wealth deprivations were combined, women were significantly (P&lt;0.01) least likely to seek assistance from SBA (OR=0.18, 95% CI: 0.14-0.24) and FBD (OR=0.17, 95% CI: 0.12-0.22); and when all three deprivations were combined women were less likely to receive ANC at least once (OR=0.16, 95% CI: 0.12-0.22) than those who were not deprived. Programmes should be undertaken to expand maternal health voucher schemes in more sub-districts and quality of care should be ensured for equal accessibility and availability of MHCSs targeting deprived and disadvantaged areas and women to ensure safe motherhood practices in Bangladesh. Our findings show that the situation of maternal health care in Bangladesh is not satisfactory.Antenatal care

Can voucher scheme enhance primary care provision for older adults: cross-sectional study in Hong Kong

BackgroundThe Hong Kong government has launched the Elderly Health Care Voucher (EHCV) scheme to facilitate primary care in the private sector for older adults. This study aimed to examine whether voucher use was associated with a shift of healthcare burden from the public to the private sector, vaccine uptake and continuity of care.MethodsThis cross-sectional survey recruited older adults with ≥3 chronic diseases through convenience sampling from seven general outpatient clinics, seven geriatric day hospitals, and five specialist outpatient clinics of the public healthcare sector in Hong Kong. We used multiple logistic regression to address the study objective.ResultsA total of 1032 patients participated in the survey. We included 714 participants aged 70 or above in the analysis. EHCV use was associated with higher utilization of private primary care services, including general practitioner and family doctor (Adjusted Odds Ratio (AOR) 2.67, 95% Confidence Interval (95%CI) 1.51–4.72) and Chinese medicine clinic (AOR 3.53, 95%CI 1.47–8.49). There were no significant associations of EHCV use with public general outpatient clinic attendance, Accident & Emergency attendance, and hospitalization. Furthermore, EHCV users were more likely to receive pneumococcal vaccination (AOR 2.17, 95%CI 1.22–3.85) and were less likely to visit the same doctors for chronic disease management (AOR 0.10, 95%CI 0.01–0.73).ConclusionsWhile the EHCV may promote private primary care utilization and preventive care, older patients continue to rely on public services and the EHCV may worsen continuity of care. Policy-makers should designate voucher usage for chronic disease management and continuity of care.

Healthcare vouchers for better elderly services? Input from private healthcare service providers in Hong Kong.

Hong Kong's health system comprises parallel and segmented public and private financed and provided sectors, in which access to the limited public primary healthcare has been an issue. This gave the government the impetus to implement the Elderly Healthcare Voucher Scheme since 2009, providing Hong Kong resident aged 65 and above an annual entitlement of HK$2,000 to purchase private primary healthcare. This was to reduce the demand for public healthcare and encourage the use of private preventive care and chronic disease management. To evaluate the effectiveness and impact of the voucher scheme, in-depth understanding from the providers' perspectives on implementation barriers and facilitators was studied. The perspectives of 33 service providerswere sought through five focus group discussions and seven telephone interviews between 2016 and 2017. Mixed sampling strategies were used, and the discussion covered three main areas: (a) factors that affect the impact of voucher scheme in bridging the private and public primary healthcare sector; (b) perceived barriers to participation in the voucher scheme and (c) potential enhancement of the voucher scheme. Participants agreed that the voucher scheme encouraged uptake of private primary care for acute episodes, but not for chronic disease management and rehabilitation due to inadequate financial entitlements and the elderly persons' lack of knowledge on the services covered. Low financial incentives, tedious administrative work and inadequate communications were identified as barriers for enrolment. The voucher scheme has resulted in increased utilisation of private primary healthcare but has not reduced the demand for public primary healthcare. Fundamental questions remain about the scheme's potential role in improving universal health coverage and financial sustainability which are related to the program design and to whether this is the better mechanism, or a complementary mechanism to address some of the more complex health system priorities including better chronic disease management.

Assessing Effectiveness of Multipurpose Voucher Scheme to Enhance Contraceptive Choices, Equity, and Child Immunization Coverage: Results of an Interventional Study from Pakistan.

BackgroundPakistan has a high total fertility and unmet contraceptive need and is the fifth most populous country. This research aims to assess the effectiveness of a subsidized, multi-purpose voucher intervention to enhance the client–provider interaction for improved contraceptive counseling resulting in a potential increase in the modern methods uptake, continued use, and its impact on equity through better targeting, while increasing uptake of postnatal care and child immunization among women from the lowest two wealth quintiles in rural and urban communities of Punjab province, Pakistan.MethodsWe used a quasi-experimental design with pre- and post-phases in intervention and control sites in Punjab province (August 2012–March 2015). To detect a 20% increase in modern contraceptive prevalence rate compared to baseline, 1276 women were enrolled in each arm. Difference-in-differences (DID) estimates are reported for key variables. Absolute and relative index of inequality including concentration curves and concentration index are used to describe the magnitude and extent of equity.ResultsWith no net increase in modern contraception use, the intervention area, however, reported a low modern method discontinuation rate. Vaccination rates for BCG increased significantly by 14%, and 5% each for DPT, HBV, and measles. Concentration index and slope index of inequalities for first-time use of modern contraceptives, knowledge of contraceptives, receiving ANC, and delivery at health facilities were negative, indicating that the use of these services was more concentrated among the disadvantaged in intervention areas than the wealthy counterparts.ConclusionThis Greenstar-led multiple voucher model did not significantly increase modern contraceptive use in the intervention study area but positively impacted equity. The integrated approach combining contraception with child immunization led to an increase in immunization coverage. It will be important for public policy decision-makers to assess the usefulness of this approach, as a long-term provision of free contraceptive services may lead to dependency in targeted communities.

Half of children entitled to free school meals did not have access to the scheme during COVID-19 lockdown in the UK

ObjectivesThe objectives of the study were to investigate access to free school meals (FSMs) among eligible children, to describe factors associated with uptake and to investigate whether receiving FSMs was associated with measures of food insecurity in the UK using the Coronavirus (COVID-19) wave of the UK Household Longitudinal Study. Study designThe study design was cross-sectional analyses of questionnaire data collected in April 2020. MethodsSix hundred and thirty-five children who were FSM eligible with complete data were included in the analytic sample. Accessing a FSM was defined as receiving a FSM voucher or a cooked meal at school. Multivariable logistic regression was used to investigate (i) associations between characteristics and access to FSMs and (ii) associations between access to FSMs and household food insecurity measures. All analyses accounted for survey design and sample weights to ensure representativeness. ResultsFifty-one percent of eligible children accessed a FSM. Children in junior schools or above (aged 8+ years) (adjusted odds ratio [AOR]: 11.81; 95% confidence interval [CI]: 5.54, 25.19), who belonged to low-income families (AOR: 4.81; 95% CI: 2.10, 11.03) or still attending schools (AOR: 5.87; 95% CI: 1.70, 20.25) were more likely to receive FSMs. Children in Wales were less likely to access FSMs than those in England (AOR: 0.11; 95% CI: 0.03, 0.43). Receiving a FSM was associated with increased odds of recently using a food bank but not reporting feeling hungry. ConclusionsIn the month after the COVID-19 lockdown, 49% of eligible children did not receive any form of FSMs. The present analyses highlight that the voucher scheme did not adequately serve children who could not attend school during the lockdown. Moreover, more needs to be done to support families relying on income-related benefits, who still report needing to access a food bank. As the scheme may be continued in summer or in a potential second wave, large improvements will be needed to improve its reach.

Health information and health-seeking behaviour in Yemen: perspectives of health leaders, midwives and mothers in two rural areas of Yemen

BackgroundHumanitarian crises can lead to the rapid change in the health needs of women and newborns, which may give rise to a complex situation that would require various interventions as solutions. This study aimed to examine the health education and promotion patterns, health-seeking behaviour of mothers, and barriers to the use of maternal health services from public health facilities in two rural areas of Yemen.MethodsWe used a qualitative approach. We conducted in-depth interviews and focus group discussions with frontline health professionals and mothers respectively. Nine in-depth interviews were conducted with the health professionals, including 4 health leaders and 5 midwives, and 2 focus group discussions with mothers aged 18–45 years in Abyan and Lahj. Thematic analysis approach was used to analyze the data in Atlas.ti (version 8) Software.ResultsOur data showed that health education and promotion activities on maternal health were ad hoc and coverage was poor. Maternal health services were underutilized by women. According to the data from the focus group discussions, the poor quality of services, as indicated by inadequate numbers of female doctors, lack of medical equipment and medicines, and costs of services were barriers to use maternal health services. Moreover, the use of prenatal and postnatal care services was associated with women’s’ perceived need. However, according to the health professionals, the inadequate human resource, workload, and inadequate funding from government have contributed significantly to the perceived quality of maternal health services provided by public health facilities. Despite the identified barriers, we found that a safe motherhood voucher scheme was instituted in Lahj which facilitated the use of maternal health services by disadvantaged women by removing financial barriers associated with the use of maternal health services.ConclusionThis study identified several obstacles, which worked independently or jointly to minimize the delivery and use of health services by rural women. These included, inadequate funding, inadequate human resources, poor quality of health services, and high cost of services. These barriers need to be addressed to improve the use of reproductive health services in Yemen.

Did the Consumption Voucher Scheme Stimulate the Economy? Evidence from Smooth Time-Varying Cointegration Analysis

Background: The stimulus coupon plan is one of the economic relief plans used to boost Taiwan’s slumping economy in the aftermath of the COVID-19 pandemic outbreak. In order to obtain prior information to understand whether or not the stimulus coupon plan would effectively revive the economy in advance, the purpose of this study is to learn lessons from Taiwan’s consumption voucher scheme initiated during the 2007–2009 global financial crisis through evaluating the effect of the consumption voucher scheme on private consumption expenditure. Methods: The smooth time-varying cointegration analysis was applied to estimate the income elasticity of consumption, indicating the individual’s reaction to consumption vouchers in terms of private consumption expenditure, and then the multiple structural change model was estimated to identify endogenous regime changes of the income elasticity of consumption. Results: We found that the income elasticity of consumption dramatically decreased after 2007Q1, a period that covered the subprime mortgage crisis in 2007–2009 and the time of issuance of the consumption vouchers in 2009. Conclusions: We concluded that Taiwan’s consumption voucher scheme might have had either no or little effect on stimulating the economy, so policymakers should be cautioned concerning the potential ineffectiveness of the stimulus coupon plan in the future.

Improvement of Elderly Health Care Voucher Scheme in Hong Kong

Elderly Health Care Voucher Scheme is a financial support provided by the government to the elderly for having more choices in selecting private primary health care services. It has been launched for more than ten years (including pilot scheme). The success of the voucher depends on its effectiveness so that Hong Kong elderly can benefit from it. The aim of this article is to analyse whether the voucher scheme has achieved its goals and what improvement can be made. The scheme is successful in encouraging the elderly to use private primary care, considering that the participation rate of the scheme is high, and elderly could use private health care services to supplement public health care services. Yet, the amount of the subsidy is insufficient to support the needs of the elderly and the providers of the voucher are not enough for Hong Kong elderly. Also, it is found that private health care services give the old generation an impression of expensiveness and unreliable even with the support of the Health Care Voucher. To improve the Elderly Health Care Voucher Scheme and solve the problems, the government should increase the amount of the voucher, set standards for regular monitoring, cooperate with private health care providers and invite more providers. Ultimately, the elderly would enjoy greater flexibility in choosing medical services in meeting their needs and the scheme can effectively achieve its purpose.

Pursuing quality in early childhood education with a government-regulated voucher: views of parents and service providers in Hong Kong

ABSTRACT This paper critically examines parents’ and service providers’ reception of the Pre-primary Education Voucher Scheme (PEVS), which was designed to enhance the quality of early childhood education in Hong Kong. The PEVS was a universal voucher policy that was designed to harness market forces and increase direct governmental control of quality in a private education market wherein pre-academic training and competition are emphasized. This paper presents the results of a survey of 413 parents and 215 service providers. Findings indicated that despite the government’s efforts in promoting quality as ‘child-centeredness’ and the efforts of preschools in meeting the quality standards, parents remained relatively neutral about the policy's influence on preschool quality. However, all parents appreciated the financial benefits they accrued from the PEVS, and more socially-advantaged families allocated the additional disposable income on extra educational activities and programs for their children. Findings suggest the implementation of the PEVS in a fully private market might unexpectedly exacerbate inequity in educational opportunities. The enrolment size of the preschool was also found to be a determinant of respondents’ views of the PEVS. We argue the government’s idea of ‘joyful learning’ may be even harder to achieve with the current means of service governance.

Sustaining LLIN coverage with continuous distribution: the school net programme in Tanzania

Most malaria-endemic countries have struggled in the past decade to establish effective national-scale continuous distribution mechanisms for long-lasting insecticidal nets (LLINs). Since the implementation of the Tanzania National Voucher Scheme in 2004 and mass-distribution campaigns in 2009–2011 and 2015–2016, Tanzania has been committed to finding new and innovative ways of achieving and maintaining universal bed net coverage. Planning for the School Net Programme (SNP) began in 2011 and in 2013, the country piloted a SNP in three regions. Nets were distributed annually to children attending schools in selected primary and secondary grades. Intra-family re-distribution was assumed, and hence the family as a whole, rather than just the children themselves, were the targeted beneficiaries. The programme has since expanded to 14 regions and has seen six rounds of annual distribution. In its fifth year, 3 million nets were distributed at a cost of USD 3.64 per net and USD 0.60 per person-year of protection (including the net). ITN access and use were maintained at a high level (~ 50–75%) over the first 4 years of distribution within selected evaluation areas, even in the absence of a mass distribution event. Net distribution through primary schools has proven to be a feasible and effective strategy for maintaining consistently high coverage in Tanzania.

Citizen Contracting: What Went Wrong with the UK's Green Deal and Verify?

Citizen contracting describes public service provision models in which decisions traditionally taken by the State are instead taken by citizens as the recipients of that service. These decisions may relate to the choice of service provider, or to the nature of the service itself. While approaches such as voucher schemes for schools, healthcare, or childcare have been widely debated, this paper focuses on two novel approaches adopted in the UK between 2010 and 2015: the Green Deal for energy-saving home renovations and the Verify system for online identity assurance. These schemes targeted environmental and innovation objectives respectively – and both failed to achieve the intended results. The paper asks how such schemes fit within the broader taxonomy of public service delivery models which involve an element of citizen choice, and how they affect policy objectives currently embedded in public procurement rules, such as transparency and accountability. Drawing lessons from the Green Deal and Verify, it proposes criteria for evaluating citizen contracting models which take account of the full range of desiderata attached to public procurement.

Subsidized R&amp;D Collaboration: The Effect of Innovation Vouchers on Innovation Activity &amp; Performance

We study the causal effect of subsidized R&D collaboration on innovation performance. In particular, we make use of a randomized controlled trial to analyze the effect of an innovation voucher scheme in the United Kingdom that grants small and medium-sized enterprises financial support of up to 5,000 GBP for engaging the services of experts, e.g., from universities, research institutes or IP advisors, when pursuing an innovation-related project. Our findings provide evidence that the innovation voucher program successfully accelerates the execution of R&D projects with short-term effects on innovation outcomes. We find that being awarded a voucher has a positive short-term impact on product development for firms that collaborated with a university. In addition, we find a positive effect on the number of patent applications for firms indicating to be in need for specialist IP knowledge. In terms of collaboration outcomes, we can show that subsidized university-industry collaborations result in an increase of joint ventures two years after the voucher has been awarded.

Subsidized R&amp;amp;D Collaboration: The Causal Effect of Innovation Vouchers on Innovation Performance

We study the causal effect of subsidized R&D collaboration on innovation performance of small and medium-sized enterprises (SMEs). In particular, we make use of a randomized controlled trial to analyze the effect of a nationwide innovation voucher scheme in the United Kingdom that grants SMEs across all industries financial support of up to 5,000 GBP for engaging the services of experts, e.g., from universities, research institutes or IP advisors, when pursuing an innovation-related project. Our results show that the innovation voucher program successfully promotes the execution of these innovation projects with positive short- and medium-term effects on product and service development, internal processes and intellectual property protection. Based on our results, we also provide some practical guidance to further improve the effectiveness of voucher programs.

공공서비스 공급과 바우처(voucher) 사업: 사회서비스 바우처의 성공요건 분석

이 연구의 목적은 유시시장 형태의 공공서비스 공급방식인 바우처 사업의 실태를 성공요건을 중심으로 분석하고, 이를 토대로 바우처 사업을 활성화하기 위한 정책제언을 하려는 것이다. 연구대상은 바우처 사업이 가장 활성화 되어 있는 사회서비스 바우처이다. 이를 위하여 우선 공공서비스 공급에서의 유사시장 및 바우처의 의의 및 장점을 논의하였다. 이어서 바우처 사업의 성공요건을 공급자들 간 경쟁성, 수급자의 선택권, 서비스품질, 형평성, 효율성이라는 다섯 가지 변수를 중심으로 분석틀을 설정하였다. 다음에는 이러한 성공요건에 비추어 사회서비스 바우처의 실태를 실증적으로 분석한 결과, 많은 종류의 사회서비스 바우처들이 도입되어 있지만, 바우처시장이 제대로 작동하지 못하고 있음을 발견하였다. 이에 따라 전술한 다섯 가지 분석변수에 입각하여 바우처 사업을 활성화하기 위한 제도적·정책적 제언을 행하였다.

An evaluation of universal vouchers as a demand-side subsidy to change primary care utilization: A retrospective analysis of longitudinal services utilisation and voucher claims data from a survey cohort in Hong Kong

To incentivize private primary care utilization and reduce reliance on public healthcare services, Elderly Healthcare Voucher Scheme has been implemented to provide a voucher entitlement to entire older resident population for subsidising their purchase of unspecified primary healthcare services in the private sector. Our study assessed whether voucher usage is associated with reduced utilization of public healthcare services. We retrieved the public healthcare services utilization and voucher transaction data of a survey cohort of 551 participants, who were age eligible for the scheme since 2009, over the period 2009–2015. Our results showed that voucher usage was not associated with reduced utilization of public healthcare services and has encouraged dual utilization of public and private healthcare. It may be due to a generated supply-induced demand and price inflation. The finding suggests the voucher is specifically designed to address the health systems issues to achieve the effective policy objectives. Defining the specific services to be provided and the prices at which they should be offered based on the needs of specified populations is a fundamental design parameter which needs to be incorporated. The alternatives of whether primary care services should be expanded and provided in the public sector or purchased using supply/demand side instruments should be considered taking the context and goals of the health system into account.

What is the long term impact of voucher scheme on primary care? Findings from a repeated cross sectional study using propensity score matching

BackgroundVouchers are increasingly used as a demand-side subsidy to reduce financial hardship and improve quality of services. Elderly Healthcare Voucher Scheme has been introduced by the Hong Kong Government since 2009 to provide subsidy to elderly aged 65 and above to visit ten different types of private primary care providers for curative, preventive and chronic disease management. Several enhancements have been made over the past few years. This paper (as part of an evaluation study of this unique healthcare voucher scheme) aims to assess the long term impact of the voucher scheme in encouraging the use of primary care services.MethodsTwo rounds of cross-sectional survey among elderly in Hong Kong were conducted in 2010 and 2016. Propensity score matching and analysis were used to compare changes in perception and usage of vouchers over time.Results61.5% of respondents in 2016 agreed “the scheme encourages me to use more private primary care services”, a significant increase from 36.2% in 2010. Among those who agreed in 2016, the majority thought the voucher scheme would encourage them to use acute services (90.3%) in the private sector, rather than preventive care (40.3%) and chronic disease management (12.2%). Respondents also reported that their current usual choice of care was visiting “both public and private doctors” (61.9%), representing a significant increase (up from 48.4%) prior to their use of voucher.ConclusionsThe voucher scheme has encouraged the use of more private care services, particularly acute services rather than disease prevention or management of chronic disease. However, there needs to be caution that the untargeted and open-ended nature of voucher scheme could result in supply-induced demand which would affect long term financial sustainability. The dual utilization of health services in both the public and private sector may also compromise continuity and quality of care. The design of the voucher needs to be more specific, targeting prevention and chronic disease management rather than unspecified care which is mainly acute and episodic in order to maximize service delivery capacity as a whole for equitable access in universal health coverage and to contribute to a sustainable financing system.