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Wahlberg K, Pape K, Austad B, Asheim A, Anthun KS, Bjørngaard JH, Vie GÅ. School absence policy and healthcare use: a difference-in-difference cohort analysis. Fam Pract 2024:cmae042. [PMID: 39240869 DOI: 10.1093/fampra/cmae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2024] Open
Abstract
BACKGROUND A national policy in Norway demanding certificates for medical absences in upper secondary school was implemented in 2016, leading to an increase in general practitioner (GP) visits in this age group. OBJECTIVES To assess the policy's effect on the use of primary and specialist healthcare. METHODS A cohort study following all Norwegian youth aged 14-21 in the years 2010-2019 using a difference-in-differences approach comparing exposed cohorts expected to attend upper secondary school after the policy change in 2016 with previous unexposed cohorts. Data were collected from national registries. RESULTS The absence policy led to the increased number of contacts with GPs for exposed cohorts during all exposed years, with estimated incidence rate ratios (IRRs) in the range from 1.14 (95% confidence intervals [CI] 1.11-1.18) to 1.25 (95% CI 1.21-1.30). Consultations for respiratory tract infections increased during exposed years. However, there was no conclusive policy-related difference in mental health consultations with GPs. In specialist healthcare we did not find conclusive evidence of an effect of absence policy on the risk of any contact per school year, but there was a slightly increased risk of contacts with ear-nose-throat specialist services. CONCLUSIONS We found an increase in general practice contacts attributable to the school absence policy. Apart from a possible increase in ear-nose-throat contacts, increased GP attention did not increase specialized healthcare.
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Affiliation(s)
- Kirsti Wahlberg
- Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Post box 8905, 7491 Trondheim, Norway
| | - Kristine Pape
- Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Post box 8905, 7491 Trondheim, Norway
- Trondheim Municipality, Post box 2300 Torgarden, 7004 Trondheim, Norway
| | - Bjarne Austad
- General Practice Research Unit, Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Post box 8905, 7491 Trondheim, Norway
| | - Andreas Asheim
- Center for Health Care Improvement, St. Olav's University Hospital, Post box 3250 Torgarden, 7006 Trondheim, Norway
- Department of Mathematical Sciences, NTNU Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Kjartan S Anthun
- Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Post box 8905, 7491 Trondheim, Norway
- Department of Health Research, SINTEF Digital, Post box 4760 Torgarden, 7465 Trondheim, Norway
| | - Johan H Bjørngaard
- Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Post box 8905, 7491 Trondheim, Norway
- Faculty of Nursing and Health Sciences, Nord University, Post box 93, 7601 Levanger, Norway
| | - Gunnhild Å Vie
- General Practice Research Unit, Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Post box 8905, 7491 Trondheim, Norway
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Haaga T, Böckerman P, Kortelainen M, Tukiainen J. Effects of nurse visit copayment on primary care use: Do low-income households pay the price? JOURNAL OF HEALTH ECONOMICS 2024; 94:102866. [PMID: 38428266 DOI: 10.1016/j.jhealeco.2024.102866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 02/16/2024] [Accepted: 02/24/2024] [Indexed: 03/03/2024]
Abstract
Nurses are increasingly providing primary care, yet the literature on cost-sharing has paid little attention to nurse visits. We employ a staggered difference-in-differences design to examine the effects of adopting a 10-euro copayment for nurse visits on the use of public primary care among Finnish adults. We find that the copayment reduced nurse visits by 9%-10% during a one-year follow-up. There is heterogeneity by income in absolute terms, but not in relative terms. The spillover effects on general practitioner (GP) use are negative but small, with varying statistical significance. We also analyze the subsequent nationwide abolition of the copayment. However, we refrain from drawing causal conclusions from this due to the lack of credibility in the parallel trends assumption. Overall, our analysis suggests that moderate copayments can create a greater barrier to access for low-income individuals. We also provide an example of using a pre-analysis plan for retrospective observational data.
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Affiliation(s)
- Tapio Haaga
- Turku School of Economics, University of Turku, FI-20014, Finland; Finnish Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland.
| | - Petri Böckerman
- Jyväskylä University School of Business and Economics, University of Jyväskylä, P.O. Box 35, FI-40014, Finland; Labour Institute for Economic Research LABORE, Arkadiankatu 7, FI-00100 Helsinki, Finland
| | - Mika Kortelainen
- Turku School of Economics, University of Turku, FI-20014, Finland; Finnish Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland
| | - Janne Tukiainen
- Turku School of Economics, University of Turku, FI-20014, Finland
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Wahlberg K, Pape K, Austad B, Vie GÅ. Use of general practitioner services among youth and young adults in Norway from 2006 to 2021. Scand J Prim Health Care 2023; 41:505-515. [PMID: 37966167 PMCID: PMC11001332 DOI: 10.1080/02813432.2023.2280045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/31/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE To describe the frequency and content of contacts with general practitioners (GPs) among youth and young adults by sex, age and time, emphasizing mental health, sexual health and respiratory tract infections. DESIGN Registry-based population-wide cohort study. SETTING General practice in Norway 2006-2021. SUBJECTS Norwegian residents aged 13-25 within the study period. MAIN OUTCOME MEASURES Contacts with GPs and out-of-hours services, including type of contact, specific procedures and diagnoses. RESULTS Average number of GP consultations increased over the study period for all age groups. Conversation therapy and time-consuming consultations increased over time, while chlamydia testing and contraceptive guidance decreased among young women. Consultations with mental health diagnoses increased substantially over the study period for all age groups. Use of GP and out-of-hours services increased with age, with a peak at the end of upper secondary school. Youth more often met their own regular GP when consulting for mental health diagnoses than for respiratory tract infections. CONCLUSION This study confirmed the continuing trend of increasing use of general practice services among youth, with an increase in conversation therapy and consultations with mental health diagnoses. Procedures related to sexual health became less common. Youth usually meet their regular GP for consultations, in particular those whose diagnosis indicates the highest need of continuity.
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Affiliation(s)
- Kirsti Wahlberg
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Kristine Pape
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Bjarne Austad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- General practice research unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Gunnhild Åberge Vie
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- General practice research unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
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Xu M, Bittschi B. Does the abolition of copayment increase ambulatory care utilization?: a quasi-experimental study in Germany. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:1319-1328. [PMID: 35084631 DOI: 10.1007/s10198-022-01430-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 01/06/2022] [Indexed: 06/14/2023]
Abstract
Due to a problematic situation with public finances, Germany introduced a copayment scheme for ambulatory care visits in 2004. In 2012, Germany achieved a balanced budget, and copayment was abolished on the 1st of January 2013. This policy change offers a rare opportunity to explore the impact of the abolition of copayment, compared to the much more frequently studied introduction of copayment. We therefore investigate the development of ambulatory care and inpatient care utilization following this policy change among people over 50 in Germany, as well as the heterogeneous impacts among vulnerable people, such as the low-income population, the chronically ill and the elderly over the age of 65. We use data from the Survey of Health, Ageing and Retirement in Europe and adopt a difference-in-differences approach with matching. We found that the abolition of copayment only caused an increase in ambulatory care use in the shorter term, while leading to a significant reduction in the longer term. In addition, we find a negative effect on inpatient care use, i.e., the hospitalization offset effect. Finally, we demonstrate that vulnerable people were more sensitive to the abolition of copayment.
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Affiliation(s)
- Mingming Xu
- School of Public Health (Shenzhen), Sun Yat-sen University, Gongchang Road 66, Shenzhen, 518107, China.
- Department of Economics and Management, Karlsruhe Institute of Technology, Kronenstraβe 34, 76133, Karlsruhe, Germany.
| | - Benjamin Bittschi
- Austrian Institute of Economic Research (WIFO), Arsenal, Objekt 20, 1030, Vienna, Austria
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Sevilla-Dedieu C, Billaudeau N, Paraponaris A. Healthcare consumption after a change in health insurance coverage: a French quasi-natural experiment. HEALTH ECONOMICS REVIEW 2020; 10:17. [PMID: 32529529 PMCID: PMC7291705 DOI: 10.1186/s13561-020-00275-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/29/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Compared with the number of studies performed in the United States, few studies have been conducted on the link between health insurance and healthcare consumption in Europe, likely because most European countries have compulsory national health insurance (NHI) or a national health service (NHS). Recently, a major French private insurer, offering voluntary complementary coverage in addition to the compulsory NHI, replaced its single standard package with a range of offers from basic coverage (BC) to extended coverage (EC), providing a quasi-natural experiment to test theoretical assumptions about consumption patterns. METHODS Reimbursement claim data from 85,541 insurees were analysed from 2009 to 2018. Insurees who opted for EC were matched to those still covered by BC with similar characteristics. Difference-in-differences (DiD) models were used to compare both the monetary value and physical quantities of healthcare consumption before and after the change in coverage. RESULTS As expected, the DiD models revealed a strongly significant, though transitory (mainly during the first year), increase after the change in coverage for EC insurees, particularly for costly care such as dental prostheses and spectacles. Surprisingly, consumption seemed to precede the change in coverage, suggesting that one possible determinant of opting for more coverage may be previous unplanned expenses. CONCLUSION Both catching-up behaviour and moral hazard are likely to play a role in the observed increase in healthcare consumption.
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Affiliation(s)
| | | | - Alain Paraponaris
- Aix-Marseille Univ, CNRS, EHESS, Centrale Marseille, AMSE, Marseille, France
- ORS PACA, South-Eastern Health Observatory, Marseille, France
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Gaughan J, Gutacker N, Grašič K, Kreif N, Siciliani L, Street A. Paying for efficiency: Incentivising same-day discharges in the English NHS. JOURNAL OF HEALTH ECONOMICS 2019; 68:102226. [PMID: 31521026 DOI: 10.1016/j.jhealeco.2019.102226] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 07/04/2019] [Accepted: 08/13/2019] [Indexed: 05/27/2023]
Abstract
We study a pay-for-efficiency scheme that encourages hospitals to admit and discharge patients on the same calendar day when clinically appropriate. Since 2010, hospitals in the English NHS are incentivised by a higher price for patients treated as same-day discharge than for overnight stays, despite the former being less costly. We analyse administrative data for patients treated during 2006-2014 for 191 conditions for which same-day discharge is clinically appropriate - of which 32 are incentivised. Using difference-in-difference and synthetic control methods, we find that the policy had generally a positive impact with a statistically significant effect in 14 out of the 32 conditions. The median elasticity is 0.24 for planned and 0.01 for emergency conditions. Condition-specific design features explain some, but not all, of the differential responses.
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Affiliation(s)
- James Gaughan
- Centre for Health Economics, University of York, United Kingdom.
| | - Nils Gutacker
- Centre for Health Economics, University of York, United Kingdom
| | - Katja Grašič
- Centre for Health Economics, University of York, United Kingdom
| | - Noemi Kreif
- Centre for Health Economics, University of York, United Kingdom
| | - Luigi Siciliani
- Department of Economics and Related Studies, University of York, United Kingdom
| | - Andrew Street
- Department of Health Policy, The London School of Economics and Political Science, United Kingdom
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Walsh B, Nolan A, Brick A, Keegan C. Did the expansion of free GP care impact demand for Emergency Department attendances? A difference-in-differences analysis. Soc Sci Med 2019; 222:101-111. [DOI: 10.1016/j.socscimed.2018.12.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 11/26/2022]
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