Introducing a GP copayment in Australia: Who would carry the cost burden?

Personalized messaging enhances hospital debt collection while prosocial appeals fail: Evidence from a field experiment

Objective

This study aimed to understand how different communication strategies influence patients' behaviour in paying unpaid hospital bills. The research focused on a healthcare system where patients have to pay a significant portion of their medical costs out-of-pocket.

Methods

The research was conducted in collaboration with a debt collection agency in Latvia. The field experiment involved 9196 individuals with unpaid hospital bills. These individuals received randomly assigned reminders through mobile text messages and e-mails. The study compared the effectiveness of personalized messages, which included the recipient's name, with generic reminders and messages that appealed to social norms or public good contributions.

Results

The findings revealed that personalized messages, specifically those that included the recipient's name, significantly improved payment rates compared with generic reminders. Conversely, messages that used social norms or public good appeals did not have a significant impact on payment rates.

Conclusions

The study highlights the importance of personalized communication strategies in improving hospital debt collection. Even simple, cost-effective modifications in communication, like adding the recipient's name, can significantly enhance payment compliance. This approach not only keep the financial books of healthcare providers balanced but also suggests that personalized strategies can be extended to other areas of healthcare management. However, while these findings are promising, they indicate that more personalized and nuanced communication strategies are needed to address the broader issue of unpaid hospital bills effectively.

Challenges for Medicare and universal health care in Australia since 2000

OBJECTIVES

To identify the financing and policy challenges for Medicare and universal health care in Australia, as well as opportunities for whole-of-system strengthening.

STUDY DESIGN

Review of publications on Medicare, the Pharmaceutical Benefits Scheme, and the universal health care system in Australia published 1 January 2000 - 14 August 2021 that reported quantitative or qualitative research or data analyses, and of opinion articles, debates, commentaries, editorials, perspectives, and news reports on the Australian health care system published 1 January 2015 - 14 August 2021. Program-, intervention- or provider-specific articles, and publications regarding groups not fully covered by Medicare (eg, asylum seekers, prisoners) were excluded.

DATA SOURCES

MEDLINE Complete, the Health Policy Reference Centre, and Global Health databases (all via EBSCO); the Analysis & Policy Observatory, the Australian Indigenous HealthInfoNet, the Australian Public Affairs Information Service, Google, Google Scholar, and the Organisation for Economic Co-operation and Development (OECD) websites.

RESULTS

The problems covered by the 76 articles included in our review could be grouped under seven major themes: fragmentation of health care and lack of integrated health financing, access of Aboriginal and Torres Strait Islander people to health services and essential medications, reform proposals for the Pharmaceutical Benefits Scheme, the burden of out-of-pocket costs, inequity, public subsidies for private health insurance, and other challenges for the Australian universal health care system.

CONCLUSIONS

A number of challenges threaten the sustainability and equity of the universal health care system in Australia. As the piecemeal reforms of the past twenty years have been inadequate for meeting these challenges, more effective, coordinated approaches are needed to improve and secure the universality of public health care in Australia.

Does the abolition of copayment increase ambulatory care utilization?: a quasi-experimental study in Germany

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.

Equity in access to zero-fees and low-cost Primary Health Care in Aotearoa New Zealand: Results from repeated waves of the New Zealand Health Survey, 1996-2016

Primary Health Care in Aotearoa New Zealand is mainly funded through capitation-based funding to general practices, supplemented by a user co-payment. Funding is designed in part to keep the costs of care low for key groups in the population who have higher health needs. We investigated changes in the socio-demographic determinants of no-cost and low-cost access to Primary Health Care using data from sequential waves of the New Zealand Health Survey (1996/97-2016/17). Fees paid were self-reported and inflated using CPI-adjustment to the value of the 2018NZD. Over the 20-year study period, there was an increase in the population accessing low-cost care. Access to low-cost care was particularly high for Pacific people, but also higher for Māori and Asian people compared to Other/New Zealand European ethnicities. Area-level deprivation was a stronger predictor of access to low-cost care for non-Māori than for Māori. Although Māori were more likely than non-Māori to access low-cost care at all levels of deprivation, this was less evident in more deprived compared to more affluent areas. Given ongoing reported inequity for Māori being less able to afford primary health care, we suggest that future policies to improve access should be fully aligned with the articles of Te Tiriti o Waitangi and should focus on equity.