Introducing co-payment for consultant specialist services.
BACKGROUND
Full medical coverage may often result in overuse. Cost-sharing and the introduction of a co-payment have been shown to cause a reduction in the use of medical services.


OBJECTIVE
To assess the effects of the recently introduced co-payment for consultant specialist services on patient utilization of these services in southern Israel.


METHODS
Computerized utilization data on specialist services for 6 months before and 6 months after initiation of co-payment were retrieved from the database of Israel's largest health management organization.


RESULTS
A decrease of 4.5% was found in the total number of visits to Soroka Medical Center outpatient clinics and 6.8% to community-based consultants. An increase of 20.1% was noted in the number of non-actualized visits to the outpatient clinics. A decrease of 6.2% in new visits to hospital outpatient clinics and 6.5% to community clinics was found. A logistic regression model showed that the residents of development towns and people aged 75+ and 12-34 were more likely not to keep a prescheduled appointment.


CONCLUSIONS
After introduction of a modest co-payment, a decrease in the total number of visits to specialists with an increase in "no-shows" was observed. The logistic regression model suggests that people of lower socioeconomic status are more likely not to keep a prescheduled appointment.
Vardy
Daniel A
DA
Clalit Health Services, Southern District, Beer Sheva, Israel. dvardy@bgu.ac.il
Freud
Tami
T
Shvartzman
Pesach
P
Sherf
Michael
M
Spilberg
Ofer
O
Goldfarb
Dan
D
Mor-Yosef
Shlomo
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities / Q000191:economics; D002648:Child; D002675:Child, Preschool; D005260:Female; D006279:Health Maintenance Organizations / Q000191:economics*; D006764:Hospitals, Community / Q000191:economics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007557:Israel; D008297:Male; D008875:Middle Aged; D011445:Prospective Payment System / Q000191:economics*; D012017:Referral and Consultation / Q000191:economics*; D012189:Retrospective Studies; D012959:Socioeconomic Factors