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Zin CS, Ab Rahman NS, Mohamed Nazar NI, Kurdi A, Godman B. Trends in the Cost of Medicines, Consultation Fees and Clinic Visits in Malaysia's Private Primary Healthcare System: Employer Health Insurance Coverage. J Multidiscip Healthc 2023; 16:1683-1697. [PMID: 37350986 PMCID: PMC10284298 DOI: 10.2147/jmdh.s403589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/08/2023] [Indexed: 06/24/2023] Open
Abstract
Objective To examine trends in the cost of medicines, consultation fees and clinic visits among the employees covered by the employer health insurance in Malaysia's private primary healthcare system in Malaysia. Designs Retrospective cross-sectional study. Setting PMCare claims database from January 2016 to August 2019. Participants A total of 83,556 outpatient clinic visits involving 10,150 IIUM employees of the International Islamic University Malaysia (IIUM) to private general practitioners (GPs). During the study period, IIUM adopts the incentive structure of capping coverage at Ringgit Malaysia (RM) 45/outpatient visit (USD 10.58) to cover for consultation fees and medicine costs. Main Outcome Measures The monthly percentage change in the number of clinic visits, medicine costs, consultation fees and total costs between January 2016 and August 2019. A simple linear regression using Stata v15.1 was also performed to measure the association between the characteristics of the prescribed medicines and medicine charges. Results The number of clinic visits per patient increased by 17% from January 2016 to August 2019, with consultation fees increasing by 113.9% and total costs by 7.9% per clinic visit per patient. Conversely, the cost of medicines and the number of medicines prescribed per clinic visit per patient decreased by 39.7% and 6.3%, respectively. Conclusion Within the incentive structure of capping the total amount of coverage per clinic visit, medicine costs were reduced by decreasing the number of medicines prescribed, to offset the increased consultation fees. This may create perverse incentives that affect medicine use with negative consequences for the health system and health insurers.
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Affiliation(s)
- Che Suraya Zin
- Big Data Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Norny Syafinaz Ab Rahman
- Big Data Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Nor Ilyani Mohamed Nazar
- Big Data Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Pharmacology and Toxicology, College of Pharmacy, Hawler Medical University, Erbil, Kurdistan Region Government, Iraq
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
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Nichani P, Trope GE, Buys YM, Markowitz SN, El-Defrawy S, Ngo G, Markowitz M, Jin YP. Frequency and source of prescription eyewear insurance coverage in Ontario: a repeated population-based cross-sectional study using survey data. CMAJ Open 2021; 9:E224-E232. [PMID: 33731423 PMCID: PMC8034370 DOI: 10.9778/cmajo.20200104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Insurance coverage may reduce cost barriers to obtain vision correction. Our aim was to determine the frequency and source of prescription eyewear insurance to understand how Canadians finance optical correction. METHODS We conducted a repeated population-based cross-sectional study using 2003, 2005 and 2013-2014 Canadian Community Health Survey data from respondents aged 12 years or older from Ontario, Canada. In this group, the cost of prescription eyewear is not covered by the government unless one is registered with a social assistance program or belongs to a specific population. We determined the frequency and source of insurance coverage for prescription eyewear in proportions. We used survey weights provided by Statistics Canada in all analyses to account for sample selection, a complex survey, and adjustments for seasonal effect, poststratification, nonresponse and calibration. We compared unadjusted proportions and adjusted prevalence ratios (PRs) of having insurance. RESULTS Insurance covered all or part of the costs of prescription eyewear for 62% of Ontarians in all 3 survey years. Of those insured, 84.1%-86.0% had employer-sponsored coverage, 9.0%-10.3% had government-sponsored coverage, and 5.7%-6.8% had private plans. Employer-sponsored coverage remained constant for those in households with postsecondary graduation but decreased significantly for those in households with less than secondary school graduation, from 67.0% (95% confidence interval [CI] 63.2%-70.8%) (n = 175 000) in 2005 to 54.6% (95% CI 50.1%-59.2%) (n = 123 500) in 2013-2014. Government-sponsored coverage increased significantly for those in households with less than secondary school graduation, from 29.2% (95% CI 25.5%-32.9%) (n = 76 400) in 2005 to 41.7% (95% CI 37.2%-46.1%) (n = 93 900) in 2013-2014. In 2013-2014, Ontarians in households with less than secondary school graduation were less likely than those with secondary school graduation to report employer-sponsored coverage (adjusted PR 0.79, 95% CI 0.75-0.84) but were more likely to have government-sponsored coverage (adjusted PR 1.27, 95% CI 1.06-1.53). INTERPRETATION Sixty-two percent of Ontarians had prescription eyewear insurance in 2003, 2005 and 2013-2014; the largest source of insurance was employers, primarily covering those with higher education levels, whereas government-sponsored insurance increased significantly among those with lower education levels. Further research is needed to elucidate barriers to obtaining prescription eyewear and the degree to which affordability impairs access to vision correction.
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Affiliation(s)
- Prem Nichani
- Faculty of Medicine (Nichani), Institute of Health Policy, Management and Evaluation (Nichani), Department of Ophthalmology and Vision Sciences (Trope, Buys, Markowitz, El-Defrawy, Jin) and Dalla Lana School of Public Health (Jin), University of Toronto; Toronto Western Hospital (Trope, Buys, Markowitz), University Health Network; Kensington Eye Institute (El-Defrawy), Toronto, Ont.; Faculty of Medicine (Ngo), University of Western Ontario, London, Ont.; private practice (Markowitz), Toronto, Ont
| | - Graham E Trope
- Faculty of Medicine (Nichani), Institute of Health Policy, Management and Evaluation (Nichani), Department of Ophthalmology and Vision Sciences (Trope, Buys, Markowitz, El-Defrawy, Jin) and Dalla Lana School of Public Health (Jin), University of Toronto; Toronto Western Hospital (Trope, Buys, Markowitz), University Health Network; Kensington Eye Institute (El-Defrawy), Toronto, Ont.; Faculty of Medicine (Ngo), University of Western Ontario, London, Ont.; private practice (Markowitz), Toronto, Ont
| | - Yvonne M Buys
- Faculty of Medicine (Nichani), Institute of Health Policy, Management and Evaluation (Nichani), Department of Ophthalmology and Vision Sciences (Trope, Buys, Markowitz, El-Defrawy, Jin) and Dalla Lana School of Public Health (Jin), University of Toronto; Toronto Western Hospital (Trope, Buys, Markowitz), University Health Network; Kensington Eye Institute (El-Defrawy), Toronto, Ont.; Faculty of Medicine (Ngo), University of Western Ontario, London, Ont.; private practice (Markowitz), Toronto, Ont
| | - Samuel N Markowitz
- Faculty of Medicine (Nichani), Institute of Health Policy, Management and Evaluation (Nichani), Department of Ophthalmology and Vision Sciences (Trope, Buys, Markowitz, El-Defrawy, Jin) and Dalla Lana School of Public Health (Jin), University of Toronto; Toronto Western Hospital (Trope, Buys, Markowitz), University Health Network; Kensington Eye Institute (El-Defrawy), Toronto, Ont.; Faculty of Medicine (Ngo), University of Western Ontario, London, Ont.; private practice (Markowitz), Toronto, Ont
| | - Sherif El-Defrawy
- Faculty of Medicine (Nichani), Institute of Health Policy, Management and Evaluation (Nichani), Department of Ophthalmology and Vision Sciences (Trope, Buys, Markowitz, El-Defrawy, Jin) and Dalla Lana School of Public Health (Jin), University of Toronto; Toronto Western Hospital (Trope, Buys, Markowitz), University Health Network; Kensington Eye Institute (El-Defrawy), Toronto, Ont.; Faculty of Medicine (Ngo), University of Western Ontario, London, Ont.; private practice (Markowitz), Toronto, Ont
| | - Gordon Ngo
- Faculty of Medicine (Nichani), Institute of Health Policy, Management and Evaluation (Nichani), Department of Ophthalmology and Vision Sciences (Trope, Buys, Markowitz, El-Defrawy, Jin) and Dalla Lana School of Public Health (Jin), University of Toronto; Toronto Western Hospital (Trope, Buys, Markowitz), University Health Network; Kensington Eye Institute (El-Defrawy), Toronto, Ont.; Faculty of Medicine (Ngo), University of Western Ontario, London, Ont.; private practice (Markowitz), Toronto, Ont
| | - Michelle Markowitz
- Faculty of Medicine (Nichani), Institute of Health Policy, Management and Evaluation (Nichani), Department of Ophthalmology and Vision Sciences (Trope, Buys, Markowitz, El-Defrawy, Jin) and Dalla Lana School of Public Health (Jin), University of Toronto; Toronto Western Hospital (Trope, Buys, Markowitz), University Health Network; Kensington Eye Institute (El-Defrawy), Toronto, Ont.; Faculty of Medicine (Ngo), University of Western Ontario, London, Ont.; private practice (Markowitz), Toronto, Ont
| | - Ya-Ping Jin
- Faculty of Medicine (Nichani), Institute of Health Policy, Management and Evaluation (Nichani), Department of Ophthalmology and Vision Sciences (Trope, Buys, Markowitz, El-Defrawy, Jin) and Dalla Lana School of Public Health (Jin), University of Toronto; Toronto Western Hospital (Trope, Buys, Markowitz), University Health Network; Kensington Eye Institute (El-Defrawy), Toronto, Ont.; Faculty of Medicine (Ngo), University of Western Ontario, London, Ont.; private practice (Markowitz), Toronto, Ont.
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Allin S, Farmer J, Quiñonez C, Peckham A, Marchildon G, Panteli D, Henschke C, Fattore G, Lamloum D, Holden ACL, Rice T. Do health systems cover the mouth? Comparing dental care coverage for older adults in eight jurisdictions. Health Policy 2020; 124:998-1007. [PMID: 32712013 DOI: 10.1016/j.healthpol.2020.06.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/17/2020] [Accepted: 06/26/2020] [Indexed: 11/30/2022]
Abstract
Oral health is an important component of general health, yet there is limited financial protection for the costs of oral health care in many countries. This study compares public dental care coverage in a selection of jurisdictions: Australia (New South Wales), Canada (Alberta), England, France, Germany, Italy, Sweden, and the United States. Drawing on the WHO Universal Coverage Cube, we compare breadth (who is covered), depth (share of total costs covered), and scope (services covered), with a focus on adults aged 65 and older. We worked with local experts to populate templates to provide detailed and comparable descriptions of dental care coverage in their jurisdictions. Overall most jurisdictions offer public dental coverage for basic services (exams, x-rays, simple fillings) within four general types of coverage models: 1) deep public coverage for a subset of the older adult population based on strict eligibility criteria: Canada (Alberta), Australia (New South Wales) and Italy; 2) universal but shallow coverage of the older adult population: England, France, Sweden; 3) universal, and predominantly deep coverage for older adults: Germany; and 4) shallow coverage available only to some subgroups of older adults in the United States. Due to the limited availability of comparable data within and across jurisdictions, further research would benefit from standardized data collection initiatives for oral health measures.
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Affiliation(s)
- Sara Allin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; North American Observatory on Health Systems and Policies.
| | - Julie Farmer
- North American Observatory on Health Systems and Policies; Faculty of Dentistry, University of Toronto, Canada
| | | | - Allie Peckham
- North American Observatory on Health Systems and Policies; Edson College of Nursing and Health Innovation, Arizona State University
| | - Gregory Marchildon
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; North American Observatory on Health Systems and Policies
| | - Dimitra Panteli
- Department of Health Care Management, Technische Universität Berlin, Germany
| | - Cornelia Henschke
- Department of Health Care Management, Technische Universität Berlin, Germany; Faculty of Health Sciences Brandenburg, Brandenburg University of Technology Cottbus -Senftenberg, Germany
| | - Giovanni Fattore
- Department of Social and Political Sciences, Bocconi University, Italy
| | - Demetrio Lamloum
- Department of Social and Political Sciences, Bocconi University, Italy
| | - Alexander C L Holden
- The University of Sydney School of Dentistry, Faculty of Medicine and Health, Australia
| | - Thomas Rice
- North American Observatory on Health Systems and Policies; Fielding School of Public Health, Department of Health Policy and Management, University of California, Los Angeles, United States
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Ark TK, Kesselring S, Hills B, McGrail KM. Population Data BC: Supporting population data science in British Columbia. Int J Popul Data Sci 2020; 4:1133. [PMID: 32935036 PMCID: PMC7480325 DOI: 10.23889/ijpds.v5i1.1133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Population Data BC (PopData) was established as a multi-university data and education resource to support training and education, data linkage, and access to individual level, de-identified data for research in a wide variety of areas including human and community development and well-being. Approach A combination of deterministic and probabilistic linkage is conducted based on the quality and availability of identifiers for data linkage. PopData utilizes a harmonized data request and approval process for data stewards and researchers to increase efficiency and ease of access to linked data. Researchers access linked data through a secure research environment (SRE) that is equipped with a wide variety of tools for analysis. The SRE also allows for ongoing management and control of data. PopData continues to expand its data holdings and to evolve its services as well as governance and data access process. Discussion PopData has provided efficient and cost-effective access to linked data sets for research. After two decades of learning, future planned developments for the organization include, but are not limited to, policies to facilitate programs of research, access to reusable datasets, evaluation and use of new data linkage techniques such as privacy preserving record linkage (PPRL). Conclusion PopData continues to maintain and grow the number and type of data holdings available for research. Its existing models support a number of large-scale research projects and demonstrate the benefits of having a third-party data linkage and provisioning center for research purposes. Building further connections with existing data holders and governing bodies will be important to ensure ongoing access to data and changes in policy exist to facilitate access for researchers
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Affiliation(s)
- T K Ark
- Population Data BC, School of Population and Public Health, UBC, Vancouver, BC, V6T 1Z3
| | - S Kesselring
- Population Data BC, School of Population and Public Health, UBC, Vancouver, BC, V6T 1Z3
| | - B Hills
- Population Data BC, School of Population and Public Health, UBC, Vancouver, BC, V6T 1Z3
| | - K M McGrail
- Population Data BC, School of Population and Public Health, UBC, Vancouver, BC, V6T 1Z3.,Centre for Health Services and Policy Research, School of Population and Public Health, UBC, Vancouver BC, V6T 1Z3
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