School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong.
J Diabetes Investig. 2021 Sep;12(9):1632-1641. doi: 10.1111/jdi.13512. Epub 2021 Feb 20.
AIMS/INTRODUCTION: To examine the impact of different levels of financial incentive in terms of fee subsidization on diabetic retinopathy screening in the private primary care setting in Hong Kong.
All general practitioners working in the private sector and registered in two electronic public databases were invited to participate. Consecutive patients with diabetes mellitus were then recruited by the participating practitioners. The recruited participants were randomly allocated to one of three screening groups with different fee levels (HK$0, HK$150 [US$19], HK$300 [US$39]) in a randomized controlled trial. Screening uptake and severity of diabetic retinopathy detected were compared.
Out of 1,688 eligible practitioners, 105 participated and invited 402 patients, with 239 initially agreeing to participate (59.5%). After randomization, 78, 75 and 76 participants in the HK$0, HK$150 and HK$300 fee groups, respectively, reconfirmed their participation and were offered screening at the relevant fee. The uptake of screening was 79.5% (62/78), 81.3% (61/75) and 63.2% (48/76), in the HK$0, HK$150 and HK$300 groups, respectively (P < 0.018). Being in the HK$150 fee group was associated with higher uptake of screening than being in the HK$300 fee group (odds ratio 2.31, P = 0.039). No significant difference was found in the prevalence of any diabetic retinopathy (33.9%, 27.9% and 37.5%, P = 0.378) or sight-threatening diabetic retinopathy (4.8%, 8.2% and 16.7%; P = 0.092) among the groups.
A screening fee of HK$150, representing approximately a half subsidy, appears to be as effective in maximizing uptake as a full subsidy (HK$0) and without deterring those at high risk of diabetic retinopathy from screening.
目的/引言：本研究旨在探讨在香港私人基层医疗环境下，不同程度的费用补贴（即全额补贴[0 港元]、半额补贴[150 港元]和全自费[300 港元]）对糖尿病视网膜病变筛查的影响。
邀请所有在私营部门工作并在两个电子公共数据库中注册的全科医生参与研究。然后由参与研究的医生连续招募糖尿病患者。在一项随机对照试验中，招募的参与者被随机分配到三个不同费用水平的筛查组（0 港元、150 港元[19 美元]和 300 港元[39 美元]）。比较了筛查的参与率和糖尿病视网膜病变的严重程度。
在 1688 名符合条件的医生中，有 105 名参与并邀请了 402 名患者，其中 239 名患者最初同意参与。随机分组后，在 0 港元、150 港元和 300 港元费用组中，分别有 78、75 和 76 名参与者重新确认参与并按相应费用接受筛查。在 0 港元、150 港元和 300 港元组中，筛查的参与率分别为 79.5%（62/78）、81.3%（61/75）和 63.2%（48/76）（P<0.018）。与 300 港元费用组相比，150 港元费用组的筛查参与率更高（比值比 2.31，P=0.039）。三组之间任何糖尿病视网膜病变的患病率（33.9%、27.9%和 37.5%，P=0.378）或威胁视力的糖尿病视网膜病变的患病率（4.8%、8.2%和 16.7%，P=0.092）均无显著差异。
筛查费用为 150 港元，相当于约半额补贴，在提高参与率方面与全额补贴（0 港元）一样有效，且不会阻止那些有高风险患糖尿病视网膜病变的人进行筛查。
