Cherkin D C, Grothaus L, Wagner E H
Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington.
Med Care. 1989 Nov;27(11):1036-45. doi: 10.1097/00005650-198911000-00005.
This study estimated the impact of a $5 copayment on office visit rates in a health maintenance organization. A quasi-experimental design was used to compare the observed changes in visit rates by state government enrollees between the year before copayments and their first year of copayments with changes between the same time periods for a control group of enrollees without copayments. Visit data for 30,415 state enrollees and 21,633 federal enrollees who were enrolled continuously for at least 12 months before and after the start of copayments were obtained from automated data systems. The introduction of a $5 copayment for office visits resulted in an estimated 10.9% decrease in primary care visits (95% confidence interval (CI): -13.4% to -8.4%) and a 3.3% drop in specialty care visits (95% CI: -15.6% to +9.0%). The effect of copayments on primary care visits by enrollees under 40 years of age was twice as large for females as for males. Copayments also had a significantly greater impact on enrollees who were high users (greater than ten primary care visits) during the year before copayments. The copayment effect was immediate and did not diminish over the 12-month study period.
本研究评估了5美元自付费用对健康维护组织门诊就诊率的影响。采用准实验设计，比较了参保州政府医保的人群在实施自付费用政策前一年和自付费用第一年门诊就诊率的实际变化，以及未实施自付费用政策的参保对照组在相同时间段内的变化。从自动化数据系统获取了30415名参保州政府医保的人群和21633名参保联邦医保的人群的就诊数据，这些人群在自付费用政策实施前后至少连续参保12个月。门诊就诊收取5美元自付费用后，初级保健就诊次数估计减少了10.9%（95%置信区间(CI)：-13.4%至-8.4%），专科护理就诊次数下降了3.3%（95%CI：-15.6%至+9.0%）。40岁以下参保人群中，女性因自付费用政策导致的初级保健就诊次数减少幅度是男性的两倍。自付费用政策对自付费用实施前一年门诊就诊次数较多（超过10次初级保健就诊）的参保人群影响也显著更大。自付费用政策的影响立竿见影，且在为期12个月的研究期间并未减弱。
