The Impact of Out-of-pocket payment on Medical Utilization and Accessibility to Different Medical Facilities – A case study of GERD Patients in Kao Kao-Ping Area of Taiwan

• Main Authors: Ju-Huei Jseng, 曾如慧
• Other Authors: Li-Chia Chen
• Format: Others
• Language: zh-TW
• Online Access: http://ndltd.ncl.edu.tw/handle/66020770196289591787

碩士 === 高雄醫學大學 === 臨床藥學研究所 === 97 === BACKGROUND: Co-payment is commonly used by health care payer to control unnecessary medical utilisation. Taiwan’s national health insurance (NHI) provides generous coverage and patients’ full freedom to access different tiers of medical facilities. NHI’s attempt to divert outpatient care utilisation into primary care by the policy that largely increased co-payment on 15th July 2005 only showed limited effects on overall diseases’ medical utilisation. To explore how out-of-pocket payment (OPP) affects the choices of accessing different tiers of medical facilities in a specific disease group, and to determine the relative importance of factors (attributes) associated with patients’ choices, we choosed gastroesophageal reflux disease (GERD), which generally does not need aggressive treatment, by using both quantitative and qualitative approaches. METHODS: Interrupted time-series analysis on regional monthly outpatient medical claims was used as quantitative approach and conducted in STATA 10.0. Number of visits and outpatients, total cost of outpatient care, and prescribing patterns were evaluated. Focus groups which recruited GERD outpatients from different tiers of medical facilities in southern Taiwan were used as qualitative approach. RESULTS: The overall numbers of outpatients were significantly increased after the policy implementation, and the trend after policy also significantly increased. The policy discouraged contacts in local hospitals and medical centers, and encouraged contacts in primary care (physicians’ clinics). Comparing against the policy’s effects on exempted group, and patients with continuous prescriptions, the policy had greater inhibiting effects on co-payment group and patients with general precriptions. Night focus groups were held in different tiers of medical facilities, recruiting 46 participants from cities and an off-shore island. Reputation of doctors and size of medical facilities are the highest priorities and unanimous considerations of all participants. Distance (transportation convenience) and advises from doctors were also important attributes for accessing medical care. Participants generally thought the current OPP is acceptable, yet expensive when go to higher tiers, especially medical centers. Despite that, they still preferred and felt worthy to visit higher tiers of medical facilities due to their trust on quality (better medical cares, drugs and equipments), and also doctors may use cost-saving strategies such as continuous prescriptions to help patients minimize OPP. CONCLUSION: Increasing OPP had shown to divert GERD outpatients from higher tier to lower tier medical facilities at the time of policy implementation. However, current OPP does not seem to impact on participants’ affordability and accessibility of treatment. Future study is suggested to determine the relative importance of attributes and how different OPP influence on decision making to help develop optimal policy.