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初级卫生保健中共同支付的效果:来自自然实验的证据。

The effects of copayment in primary health care: evidence from a natural experiment.

机构信息

Department of Health Policy, London School of Economics and Political Science (LSE), London, UK.

Center for Research in Health and Economics (CRES), Universitat Pompeu Fabra, Barcelona, Spain.

出版信息

Eur J Health Econ. 2019 Nov;20(8):1237-1248. doi: 10.1007/s10198-019-01089-4. Epub 2019 Jul 26.

Abstract

OBJECTIVE

Evaluate the effects of the 'euro per prescription' on primary health care services (number of doctor visits), through a retrospective cohort study of health care users in Catalonia (Spain). This policy, implemented in Catalonia on 23 June 2012, only lasted 6 months. This policy was introduced to improve budgetary imbalances in Spain and boost the regional and national governments' budgets.

METHODS

We used a retrospective cohort, composed of individuals who had had contact with primary healthcare services between January 1, 2005 and December 31, 2012. The econometric specification followed is a hurdle model.

RESULTS

Our results show that from October 2012 onwards there was a decrease in the average number of overall visits, particularly for individuals aged 65 years or more. However, this decline cannot be entirely attributed to the introduction of the euro per prescription policy as in October of that same year the Spanish government introduced its pharmaceutical copayment for pensioners.

CONCLUSIONS

The policies appraised in this paper reveal a clear deterrent effect among vulnerable individuals such as those with the highest probability of being unemployed and/or those individuals with chronic conditions.

摘要

目的

通过对加泰罗尼亚(西班牙)卫生保健使用者的回顾性队列研究,评估“每张处方的欧元”对初级卫生保健服务(就诊次数)的影响。该政策于 2012 年 6 月 23 日在加泰罗尼亚实施,仅持续了 6 个月。实施该政策是为了改善西班牙的预算失衡状况,并增加地区和国家政府的预算。

方法

我们使用了一个回顾性队列,该队列由 2005 年 1 月 1 日至 2012 年 12 月 31 日期间与初级卫生保健服务有过接触的个人组成。我们遵循的计量经济学规范是一个门槛模型。

结果

我们的结果表明,从 2012 年 10 月开始,总体就诊次数的平均值有所下降,特别是 65 岁及以上的人群。然而,这种下降不能完全归因于每张处方的欧元政策的引入,因为同年 10 月,西班牙政府对养老金领取者实行了药品共付额。

结论

本文评估的政策显示,对于那些失业可能性最高的弱势群体,以及那些患有慢性病的人,这些政策存在明显的抑制作用。

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