Impact of coinsurance policy change on medical care utilization among mild disease patients

Abstract

Background: The Korean healthcare system is composed of costly and inefficient structures that fail to adequately divide the functions and roles of medical care organizations. To resolve this matter, in November 2011 the government reformed the cost-sharing policy for the management of outpatients visiting general or tertiary hospitals with comparatively mild diseases. Purpose: This study aims to examine the impact of the changes in coinsurance on medical utilization for 52 mild diseases compared with 65 mild diseases to which the policy did not apply. Methods: The present study used health insurance claim data collected from 2007 to 2013. To examine the effect of policy, we compared 52 mild diseases to which the policy applied and 65 mild diseases to which the policy did not apply to determine the proportion and number of claims and the medical and drug costs. This study adjusted for factors that affect medical utilization and then segmented regression analysis was performed. Results: The analysis comparing the 65 mild diseases found that the percentage and the number of claims of clinics after the policy intervention increased, and that of general and tertiary hospitals decreased. Total medical expenses increased in all medical institutions overall, and the increase was greater in hospitals and general and tertiary hospitals than in clinics. The drug cost decreased in all medical institutions overall, and the decrease was greater in general and tertiary hospitals than in clinics and hospitals. Analysis of detail groups by income level did not find a difference in accordance with the policy intervention. Conclusion: It was found that policy intervention had an impact on healthcare utilization of medical institutions. In the future, much research will be needed in terms of patient medical results and quality management of medical services caused by changes in the medical institutions chosen by patients with mild cases.