Abstract
Prospective evaluation of the effect of a new co-payment for specialists consultations on actualization of referrals (2,432 patient), was examined. Actualization of the appointment, reasons for not actualizing, and sociodemographic characteristics were recorded. Actualization was 85.1% in community consultation clinics and 91.7% in hospital outpatient clinics. The main reasons for non actualization were: inability to reach the clinic (53.4%), the problem had resolved (15%), and co-payment (2%). In addition, 19.1% stated that they did not actualize a past consultant visit due to co-payment. Referring physicians noted that co-payment had some effect on their decision, especially with the elderly or lower income patients. A relatively small compulsory co-payment was not found to have a long term effect on utilization of specialists’ services.
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Newhouse, J. P., Manning, W. G., Morris, C. N., Orr, L. L., Duan, N., Keeler, E. B., et al., Some interim results from a controlled trial of cost sharing in health insurance. N. Engl. J. Med. 305:1501–1507, 1981.
Pearson, S. D., Sabin, J. E., and Emanuel, E. J., Ethical guidelines for physician compensation based on capitation (sounding board). N. Engl. J. Med. 339(10):689–693, 1998.
Cherkin, D. C., Grothaus, L., and Wagner, E. H., The effect of office visit copayments on utilization in a health maintenance organization. Med. Care. 27:1036–1045, 1989.
Cherkin, D. C., Grothaus, L., and Wagner, E. H., The effect of office visit copayments on preventive care services in an HMO. Inquiry 27:24–38, 1990.
Cherkin, D. C., Grothaus, L., and Wagner, E. H., Is magnitude of copayment effect related to income? Using census data for health services research. Soc. Sci. Med. 34:33–41, 1992.
Simon, G. E., VonKorff, M., and Durham, M. L., Predictors of outpatient mental health utilization by primary care patients in a health maintenance organization. Am. J. Psychiatr. 151:908–913, 1994.
O’Grady, K. F., Manning, W. G., Newhouse, J. P., and Brook, R. H., The impact of cost sharing on emergency department use. N. Engl. J. Med. 313:484–490, 1985.
Lohr, K. N., Brook, R. H., Kamberg, C. J., Goldberg, G. A., Leibowitz, A., Keesey, J., et al., Use of medical care in the Rand Health Insurance Experiment: diagnosis- and service-specific analyses in a randomized controlled trial. Med. Care. 24(Suppl 9):S1–S87, 1986.
Brook, R. H., Ware, J. E., Rogers, W. H., Brooks, R. H., and Newhouse, J. P., The effect of coinsurance on the health of adults. Results from the Rand Health Insurance Experiment, R-3055-HHS, 1984.
Selby, J. V., Fireman, B. H., and Swain, B. E., Effect of a copayment on use of the emergency department in a health maintenance organization. N, Engl. J. Med. 334:635–641, 1996.
Vardy, D. A., Freud, T., Shvartzman, P., Sherf, M., Spilberg, O., Goldfarb, D., et al., Introducing co-payment for consultant specialist services. IMAJ 8:558–562, 2006.
Beck, R. G., The effects of copayment on the poor. J. Hum. Resour. 9:129, 1974.
Scitovsky, A. A., and Synder, M. M., Effect of coinsurance on use of physician services. Soc. Secur. Bull. 35:3, 1977.
Scitovsky, A. A., and McCall, N., Coinsurance and the demand for physician services: Four years later. Soc. Secur. Bull. 40:19–27, 1977.
Roemer, M. I., Hopkins, C. E., Carr, L., and Gartside, F. Copayments for ambulatory care: Penny-wise and pound-foolish. Med. Care. 13:466–475, 1975.
Roddy, P. C, Wallen, J., and Meyers, S. M. Cost sharing and the use of health services. Med. Care. 24:873–876, 1986.
Glaser, N., Financial decisions in European health insurance. NY: New School of Social Research, 15–17, 1988.
Department of Veterans Affairs. Copayments for inpatient hospital care and outpatient medical care. Interim and final rule. Fed. Regist. 6;66(235):63445–63449, 2001.
Mapelli, V., and Lucioni, C., Spending on pharmaceuticals in Italy: Macro constraints with local autonomy. Value Health. 6 Suppl 1:S31–S45, 2003.
Reuveni, H., Sheizaf, B., Elhayany, A., Sherf, M., Limoni, Y., Scharff, S., et al., The effect of drug co-payment policy on the purchase of prescription drugs for children with infections in the community. Health Policy. 62(1):1–13, 2002
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The study was supported by a grant from the Israel National Institute for Health Policy and Health Services Research.
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Ethical approval: This study received Helsinki approval in accordance with local requirements to conduct this study (IRB committee).
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Vardy, D.A., Freud, T., Sherf, M. et al. A Co-payment for Consultant Services: Primary Care Physicians’ Referral Actualization. J Med Syst 32, 37–41 (2008). https://doi.org/10.1007/s10916-007-9105-9
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DOI: https://doi.org/10.1007/s10916-007-9105-9