J Korean Acad Community Health Nurs.  2015 Mar;26(1):11-17. 10.12799/jkachn.2015.26.1.11.

The Effect of Copayment on Medical Aid Beneficiaries in Korea

• Oh JJ
• Choi JM
• Lee HJ

• KMID: 2292697
• DOI: http://doi.org/10.12799/jkachn.2015.26.1.11

Abstract

PURPOSE
This study was to ascertain whether there are differences in health care utilization and expenditure for Type I Medical Aid Beneficiaries before and after applying Copayment.
METHODS
This study was one-group pretest posttest design study using secondary data analysis. Data for pretest group were collected from claims data of the Korea National Health Insurance Corporation and data for posttest group were collected through door to-door interviews using a structured questionnaire. A total of 1,364 subjects were sampled systematically from medical aid beneficiaries who had applied for copayment during the period from December 12, 2007 to September 25, 2008.
RESULTS
There was no negative effect of copayment on accessibility to medical services, medication adherence (p=.94), and quality of life (p=.25). Some of the subjects' health behaviors even increased preferably after applying for copayment including flu prevention (p<.001), health care examination (p=.035), and cancer screening (p=.002). However, significant suppressive effects of copayment were found on outpatient hospital visiting days (p<.001) and outpatient medical expenditure (p<.001).
CONCLUSION
Copayment does not seem to be a great influencing factor on beneficiaries'accessibility to medical services and their health behavior even though it has suppressive effects on outpatients' use of health care.

Keyword

Cost sharing; Health care costs; Medicaid; Medication adherence; Quality of life

MeSH Terms

Cost Sharing
Delivery of Health Care
Early Detection of Cancer
Health Behavior
Health Care Costs
Health Expenditures
Humans
Korea
Medicaid
Medication Adherence
National Health Programs
Outpatients
Quality of Life
Statistics as Topic
Surveys and Questionnaires

Reference

1. Ministry Health and Welfare. Introduction for medical aid program in 2010. Seoul: Ministry Health and Welfare;2009. p. 401.

2. Kim US, Nam JJ, Kim MY, Goh IS, Lee DM, Choi JS, et al. Long-term medical service use status of medical aid beneficiaries and its improvements (2007-12). Seoul: Ministry of Health and Welfare;2007. p. 399.

3. Lee YJ. A study of the factors and the regional difference of medical Aid Program recipient's medical utilization. Soc Welf Policy. 2007; 28:233–251.

4. Kephart G, Skedgel C, Sketris I, Grootendorst P, Hoar J. Effect of copayments on drug use in the presence of annual payment limits. Am J Manag Care. 2007; 13(6):328–334.

5. Kim JY, Ko SK, Yang BM. The effects of patient cost sharing on ambulatory utilization in South Korea. Health Policy. 2005; 72(3):293–300.

6. Trivedi AN, Rakowski W, Ayanian JZ. Effect of cost sharing on screening mammography in medicare health plans. N Engl J Med. 2008; 358(4):375–383. DOI: 10.1056/NEJMsa070929.

7. Gibson TB, Song X, Alemayehu B, Wang SS, Waddell JL, Bouchard JR, et al. Cost sharing, adherence, and health outcomes in patients with diabetes. Am J Manag Care. 2010; 16(8):589–600.

8. Oh JJ, Choi JM, Yu WS. Job analysis and methods for enhancing efficiency of medical aid client managers. Seoul: Ministry of Health, Welfare and Family Affairs, Dankook University;2008. p. 199.

9. Shin YE, Shin HC, Shin HW, Park EJ, Hong SW, Shin SM, et al. Study on the health status and hospital service utilization of Korea medicaid clients. Seoul: Korea Human Resource Development Institute for Health and Welfare;2007. p. 430.

10. Kang EJ, Choi EJ. 2005 the third Korea national health and nutrition examination survey: Health behaviors of adults. Seoul: Korean Institute for Health and Social Affairs;2006. p. 272.

11. Eraker SA, Kirscht JP, Becker MH. Understanding and improving patient compliance. Ann Intern Med. 1984; 100(2):258–268. DOI: 10.7326/0003-4819-100-2-258.

12. Morisky DE, Levine DM, Greene LW, Shapiro S, Russell RP, Smith CR. Five-year blood pressure control and mortality following health education for hypertensive patients. Am J Public Health. 1983; 73(2):153–162.

13. Jun FW, So KJ, Kim AY, Kim HG, Kim CW, Lee YM, et al. Case management society of America 'case management adherence guidelines 2.0'. Seoul: Hyunmoonsa;2007. p. 937.

14. Magid DJ, Koepsell TD, Every NR, Martin JS, Siscovick DS, Wagner EH, et al. Absence of association between Insurance copayments and delays in seeking emergency care among patients with myocardial infarction. N Engl J Med. 1997; 336(24):1722–1729. DOI: 10.1056/NEJM199706123362406.

15. Dranove D. The economic evolution of American health care. New Jersey, NJ: Princeton University Press;2000. p. 224.

16. Gruber J. The role of consumer copayment for health care: Lessons from RAND health insurance experiment and beyond. Washington DC: The Henry J. Kaiser Family Foundation;2006. p. 15.

17. Wong MD, Andersen R, Sherboume CD, Hays RD, Shapiro MF. Effects of cost sharing on care seeking and health status: Results from the medical outcomes study. Am J Public Health. 2001; 91(11):1889–1894.

18. Cole JA, Norman H, Weatherby LB, Walker AM. Drug copayment and adherence in chronic heart failure: Effect on cost and outcomes. Pharmacotherapy. 2006; 26(8):1157–1164. DOI: 10.1592/phco.26.8.1157.

19. Wallace NT, McConnell KJ, Gallia CA, Smith JA. How effective are copayments in reducing expenditures for low-income adult medicaid beneficiaries?experience from the oregon health plan. Health Serv Res. 2008; 43(2):515–530. DOI: 10.1111/j.1475-6773.2007.00824.x.

20. Hartung DM, Carlson MJ, Kraemer DF, Haxby DG, Ketchum KL, Greenlick MR. Impact of a medicaid copayment policy on prescription drug and health services utilization in a fee-forservice medicaid population. Med Care. 2008; 46(6):565–572. DOI: 10.1097/MLR.0b013e3181734a77.

21. Goldman DP, Joyce GF, Zheng Y. Prescription drug cost sharing: Associations with medication and medical utilization and spending and health. JAMA. 2007; 298(1):61–69. DOI: 10.1001/jama.298.1.61.

22. Yang JH. The evaluation on the effect of outpatient visit copayment policy for medicaid in Korea [dissertation]. Seoul: Korea University;2010. 120.

23. Hong SW. The effects of copayments on healthcare utilization in the type I medicaid beneficiaries [dissertation]. Seoul: Seoul National University;2009. 103.