title: The Ariadne's thread in co-payment, primary health care usage and financial crisis: findings from Cyprus public health care sector.
abstract: OBJECTIVE
  Cyprus entered a prolonged financial recession in 2011 and by early 2013 it applied for an international bail-out agreement. This presupposed massive reforms in public governance. Health sector was considerably reformed and one of the measures was the introduction of co-payment for outpatient visits to public health care sector. The scope of this study is to assess the impact of financial crisis and co-payment to public outpatient visits in Nicosia urban and greater Nicosia region.
  
  
  METHODS
  An Interrupted time-series analysis.
  
  
  METHODS
  All outpatient visits to public health care family doctor/general practitioners in Nicosia urban and greater Nicosia region from January 2011 until May of 2014 were registered and analysed.
  
  
  RESULTS
  Financial crisis did not alter outpatient visits. Introduction of co-payment led to a statistically significant decrease from the second month after its introduction (p = 0.048) (R(2) = 0.329, Q = 23.75, p = 0.137). This decrease was consistent until the end of the observational period and it did not level off.
  
  
  CONCLUSIONS
  Financial crisis did not affect outpatient visits while co-payment can be considered as a potent cost containment measure during financial recession, by normalising utilisation of healthcare resources.
authors.affiliation: Health Insurance Organization of Cyprus, Cyprus; HealthCare Management Program, Open University of Cyprus, Cyprus. Electronic address: p.petrou@gesy.org.cy.
authors.forename: P
authors.initials: P
authors.lastname: Petrou
mesh_terms: D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data*; D003535:Cyprus; D057172:Economic Recession; D005382:Financing, Personal / Q000706:statistics & numerical data*; D019981:Health Care Sector / Q000191:economics; D006801:Humans; D065186:Interrupted Time Series Analysis; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D017150:Public Sector / Q000191:economics
keywords: Co-payment; Cyprus; Financial crisis; Health care usage; Outpatient visits