User charges

Question 1

Thompson et al. 2010

Answer 1

No equity or fairness in charging sick people for the use of care.
1% of total healthcare spending in NHS was from user charges in 2009-10.
Modulating user charges for high/uncertain/low value care
Generic user charges undermine efforts to improve quality of care.
Squeezed balloon effect.
France - 80% of diabetic patients covered by protocols and excluded from copayment charge.

Question 2

Manning et al. 1987

Answer 2

RAND experiment

Question 3

Tamblyn et al. 2001

Answer 3

Quebec - reduction in use of essential drugs by 9.12% in elderly patients after user charges introduced. Also higher rate of serious adverse events and ED visits.

Question 4

Hsu et al. 2006

Answer 4

Higher cost sharing for prescription drugs resulted in worse physiological outcomes (blood pressure), more visits to the emergency department and higher mortality rates.

Question 5

Trivedi et al. 2008

Answer 5

Use of user charges reduces use of preventative care.

Question 6

Zhang and Cowling 2023.

Answer 6

California’s Public employees retirement VBID program - pay half the copayment amount if engaging in value based activities. VBID cohort associated with lower inpatient admissions and surgical procedures. Also had higher spending on use of primary care physicians and immunisations.

Question 7

Chernew et al. 2008

Answer 7

Reduced copayment rates increase adherence to treatment for chronic diseases.

Question 8

OECD 2009

Answer 8

Little reliable evidence on the impact of user charges on utilisation of healthcare in developed countries.

Question 9

Gemmill et al 2008.

Answer 9

Health effects of user charges disproportionately affect low-income groups. Drug charges also lead to forgoing of essential drugs, reduced adherence and increases risk of internsive care and mortality.

Question 10

Dumontet et al. 2017

Answer 10

France - medicine traitant led to a reduction in self-referrals.

Question 11

Anderson et al. 2001

Answer 11

Sweden - implementation of user charges led to reduced utilisation in low income group.

Question 12

Newhouse 2004

Answer 12

No significant impact on health outcomes in non-poor groups. Participants who were poor and in poor health experienced several adverse outcomes including poorly controlled hypertension and 10% increase in mortality risk.