Case 3: Patient involvement in HC payments Flashcards
What are the main themes that affect the patients decision to use HC?
- financial barriers
- structural barriers related to complex design of cost-sharing programs
- individual considerations of patient
- perceived lack of control regarding treatment choices within given treatment trajectory
What is cost-sharing (AKA user fees/patient contributions)?
- practice of sharing cost of HC between patients & insurers or other third-party payers.
What do cost-sharing payments aim?
increase awareness of healthcare costs among those insured, but may also have counter-effects.
Why do we do cost-sharing?
- rising costs of healthcare → additional source of funding
- overusing from the patients → make them more cost-conscious
What elements does cost-sharing to contribute to sustainability of HC systems rely on?
- generates additional sources of funding: through cost-sharing, some of HC costs might be shifted from public budgets to patients.
- improve efficiency in publicly financed HC: expected that when patients faced with price of HC services = reduce utilisation of unnecessary & low-value health care
*Why are co-payments the easiest way to do cost-sharing?
is it true?
- co-payment design is key factor influencing financial protection. It is the most important factor in countries where financial hardship is driven by outpatient medicines and the scope of the benefits package is adequate.
- Patient will always know how much they have to pay
- View of healthcare provider & insurer: if we know the cost of the service, then we can apply co-insurance & deductible but if don’t know then can only have co-payments.
How is cost-sharing done?
- Co-payments
- Deductibles
- Coinsurance
- Reference prices
- extra billing
What are co-payments
- patient pays a flat rate fee for a service, not a percentage
What are deductibles?
- fixed amount that patients pay OOP before their insurance coverage kicks in → have to pay from your own money!
- Doesn’t apply to GP with the idea not to discourage the use of primary care
What is coinsurance?
% of the service cost covered by the patient
- More expensive services means the patient pays more and therefore discourages utilisation
- kicks in AFTER deductible has been met
What are reference prices?
same as extra billing but for medicines where insurance covers up to certain amount for medicine/medical device but if want more expensive one, then have to pay yourself.
What is extra billing?
depending on specialist, can be charged differently for the services.
What are the incentives for cost-sharing?
- increase patient responsibility
- reducing moral hazard → only go if you really need to go to the doctor
What are the pros of cost-sharing?
- efficiency
- slowing down the rise of healthcare spending
- lower premiums in general
- having an impact on quality of care
What are the cons of cost-sharing?
- Increase hospital costs → high cost-sharing, less prevention through GP because people are not going to the GP because of the cost-sharing. When rise in hospitalisation = primary care (GP, etc) is ignored.
- Reduction of HC utilisation due to cost-sharing have = adverse health effects for those with the lowest income & in poor initial health
- quite complex and hard to understand cost-sharing (elderly, low-income)
- more administrative costs
- no patient choice
What is OOP?
a payment you make with your own money, whether or not it is reimbursed
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What is the purpose of OOP?
- as a source of revenue
- to help reduce demand for services
Who is protected through lower or zero OOP requirements?
- low-income persons (all countries)
- Children
- those with high expenditures
- people with particular diseases
- older adults
What are problems with OOP?
- Financial barrier to access = unmet need = financial hardship.
- Regressive
- Voluntary health insurance → not covered in OOP spending
- Long term care not included
What is the problem with using OOP expenses as measure of inability to access care?
can be flawed coz only reflects those who actually accessed care.
**What are informal payments?
How is impoverishing health spending measured?
- No OOP payments
- Not at risk of impoverishment after OOP payment
- At risk of impoverishment after OOP payments
- Impoverished after OOP payments
- Further impoverished after OOP payments
Explain “no OOP payments” as a measurment of impoverishing health spending
Households with no OOP payments experience no drop in household consumption