Cost-Sharing in Medical Care Can Increase Adult Mortality Risk in Lower-Income Countries
Cost-Sharing in Medical Care Can Increase Adult Mortality Risk in Lower-Income Countries
复制标题
医疗费用分摊可能会增加低收入国家的成人死亡风险
DOI：
10.1101/2021.03.03.21252857
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Buitrago G
中科院分区：
文献类型：
--
作者：
Buitrago G
患者在医疗保健中的费用分担限制了总的医疗支出，想必对潜在的患者健康几乎没有损害。这篇论文重新评估了费用分担和健康之间的联系，研究了哥伦比亚所有正规部门的劳动力，以及与工资数据和生命统计数据相联系的个人一级医疗保健利用记录。鉴于哥伦比亚国家卫生系统在多个收入门槛下实施的门诊费用分摊离散中断，我们使用回归不连续设计，发现门诊费用分摊减少了门诊护理的使用，导致常见慢性病的诊断减少，并增加了随后的急诊室就诊和住院治疗。归根结底，这些影响明显增加了死亡率，在穷人中更是如此--在低收入和高收入门槛下，7年死亡率风险的绝对差异分别增加了每1000人0.80和0.23人死亡。据我们所知，这项研究首次表明了低收入国家的费用分担与成人死亡风险之间的关系，这种关系很重要，应该纳入对费用分担政策的社会福利分析。一句话总结医疗保健中的门诊费用分担阻碍了人们的使用--但随着时间的推移，也会增加昂贵的医院服务使用并增加死亡风险。
Patient cost-sharing in medical care constrains total health spending, presumably with little harm to underlying patient health. This paper re-evaluates the link between cost-sharing and health, studying Colombia’s entire formal sector workforce with individual-level health care utilization records linked to payroll data and vital statistics. Given discrete breaks in outpatient cost-sharing imposed at multiple income thresholds by Colombia’s national health system, we use a regression discontinuity design and find that outpatient cost-sharing reduces use of outpatient care, resulting in fewer diagnoses of common chronic diseases and increasing subsequent emergency room visits and hospitalizations. Ultimately, these effects measurably increase mortality, and disproportionately so among the poor – raising the absolute difference in 7-year mortality risk by 0.80 and 0.23 deaths per 1,000 individuals at lower- and higher-income thresholds, respectively. To the best of our knowledge, this study is the first to show a relationship between cost-sharing and adult mortality risk in lower-income countries, a relationship important to incorporate into social welfare analyses of cost-sharing policies.One Sentence SummaryOutpatient cost-sharing in medical care discourages use – but over time, also increases costly hospital service use and raises mortality risk.
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影响因子：
1.9
作者：
PRENTICE, RL;KALBFLEISCH, JD
通讯作者：
KALBFLEISCH, JD
DOI：
10.2139/ssrn.3496282
发表时间：
2019-11
期刊：
Randomized Social Experiments eJournal
影响因子：
--
作者：
Jacob Goldin;I. Lurie;Janet Mccubbin
通讯作者：
Jacob Goldin;I. Lurie;Janet Mccubbin
不同临床状态的药学益处：以降胆固醇治疗为例。
DOI：
--
发表时间：
2006
期刊：
The American journal of managed care.
影响因子：
--
作者：
Goldman,DanaP;Joyce,GeoffreyF;Karaca-Mandic,Pinar
通讯作者：
Karaca-Mandic,Pinar
影响因子：
39.2
作者：
Rosen, AB;Hamel, MB;Vijan, S
通讯作者：
Vijan, S