title: Introducing co-payment for consultant specialist services.
abstract: 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.
authors.affiliation: Clalit Health Services, Southern District, Beer Sheva, Israel. dvardy@bgu.ac.il
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Vardy
authors.forename: Tami
authors.initials: T
authors.lastname: Freud
authors.forename: Pesach
authors.initials: P
authors.lastname: Shvartzman
authors.forename: Michael
authors.initials: M
authors.lastname: Sherf
authors.forename: Ofer
authors.initials: O
authors.lastname: Spilberg
authors.forename: Dan
authors.initials: D
authors.lastname: Goldfarb
authors.forename: Shlomo
authors.initials: S
authors.lastname: Mor-Yosef
mesh_terms: 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