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http://dx.doi.org/10.4332/KJHPA.2017.27.2.128

An Analysis of Effects of Differential Coinsurance Policy and Utilization of Outpatients Care by Types of Medical Institutions  

Park, Yoon-Sung (Research Institute for Healthcare Policy, Korean Medical Association)
Kim, Jin Suk (Research Institute for Healthcare Policy, Korean Medical Association)
Publication Information
Health Policy and Management / v.27, no.2, 2017 , pp. 128-138 More about this Journal
Abstract
Background: The purpose of this study is to analyze the effects of differential coinsurance policy on prescription drug coverage of outpatients by types of medical institutions. Methods: In this study, we used a sample cohort database of the National Health Insurance Service and frequency analysis and marginal logistic regression model using generalized estimating equation were used for statistical analysis. Results: The summary on the major research is followed. First, about 16% of patients who used only tertiary or general hospital due to 52 ambulatory care sensitive conditions before policy implementation moved to hospitals and clinics. However, about 57% of them still use tertiary or general hospital. Second, the factors influencing the utilization of hospitals and clinics after the implementation of the policy were gender, age, and income level. As a result, the policy is effective to reduce the medical use of outpatient mental patients in tertiary or general hospital, but the effect is not significant. Conclusion: Therefore, in order to achieve the purpose of the policy for establishing the health care delivery system, it is necessary to adjust the co-payment so as to feel the burden on the co-payment when the outpatient for 52 ambulatory care sensitive conditions is used at the tertiary or general hospital.
Keywords
Outpatients; 52 ambulatory care sensitive conditions; Differential coinsurance policy; Prescription drug coverage; Health care delivery system;
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  • Reference
1 Song SY. The difference of outpatient utilization by changing coinsurance rate on pharmaceutical cost [master's thesis]. Seoul: Seoul University; 2016.
2 Ministry of Health and Welfare. Plan on the re-establishment of functions of health care institutions. Sejong: Ministry of Health and Welfare; 2011.
3 Kim HJ. The impact of rise in outpatient coinsurance rate on outpatient healthcare service utilization [master's thesis]. Daejeon: Eulji University; 2013.
4 Kim KH. Adjustment method for tertiary hospital visits. Seoul: Research Institute for Healthcare Policy, Korean Medical Association; 2010.
5 Park EH. The difference of outpatient utilization by changing coinsurance rate on pharmaceutical cost [master's thesis]. Seoul: Yeonsei University; 2015.
6 Park HK. Impact of increasing outpatient coinsurance rate of tertiary care hospitals on outpatient utilization: focusing on acute respiratory infection and hypertension [master's thesis]. Seoul: Yeonsei University; 2011.
7 Lee EH. 2011. Impact of increasing outpatient coinsurance rate of tertiary care hospitals on outpatient utilization: focusing on diabetes mellitus [master's thesis]. Seoul: Yeonsei University; 2011.
8 Byeon JN, Ghang HY, Lee HB. Differential cost-sharing and utilization of outpatients care by types of medical institutions. Korea Soc Policy Rev 2014;21(2):35-55. DOI: https://doi.org/10.17000/kspr.21.2.201406.35.   DOI
9 Um JO. Comparisons of pre.post medical utilization by adaptation of pharmaceutical expenditure differential copayment system [master's thesis]. Seoul: Hanyang University; 2016.
10 Cheong CL, Lee TJ. The effect of increase in coinsurance rate for tertiary hospital visits on the choice among different types of medical facilities stratified by income levels in Korea. Health Econ Policy Res 2015;21(1): 103-124.
11 Chun KH, Kim HJ. Impact of increasing the level of copayments on the number of physician visits. Korean J Prev Med 1992;25(1):73-87.
12 Kan M, Suzuki W. Effects of cost sharing on the demand for physician services in Japan: evidence from a natural experiment. Jpn World Econ 2010;22(1):1-12. DOI: https://doi.org/10.1016/j.japwor.2009.06.005.   DOI
13 You CH, Kwon YD. Factors influencing medical institution selection for outpatient services. J Korean Med Assoc 2012;55(9):898-910. DOI: https://doi.org/10.5124/jkma.2012.55.9.898.   DOI
14 Jung GT. An analysis of the effect of increases in user prices on health care use and cost: the Korean experience. Korean Soc Secur Stud 1992; 8:61-113.