成本分攤機制的引入對參保人群影響的系統評價_《中國循證醫學雜志》

作者：

賈莉英 , 袁蓓蓓 , 楊冰一 , 張國杰 , 常捷 , 于海寧 , 趙世超 ,  孟慶躍

山東大學衛生管理與政策研究中心；國家衛生部衛生經濟與政策重點實驗室（濟南 250012）;

關鍵詞：

成本分攤醫療保險系統評價

DOI：

10.7507/1672-2531.20120023

視頻：

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摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　系統評價成本分攤機制的引入對參保人群的影響，為更好地設計醫療保險方案中的成本分攤方法提供科學依據。
方法　由主題專家和檢索人員討論并預試驗后確定檢索詞，共檢索綜合類、衛生類、經濟類、社會學類及灰色文獻數據庫20個，納入所有描述或評價已實施的成本分攤機制對參保人群衛生服務利用、經濟負擔和道德風險影響的文獻。用預先設計的數據提取表收集文獻內容和有關研究質量的信息，而后對所提取信息進行定性分析和描述。
結果　共納入73篇文獻，涉及澳大利亞、加拿大、中國等17個國家。統計分析結果顯示：① 成本分攤機制廣泛應用于各種醫療保險項目，目標人群包括一般人群、老人、窮人、慢性病患者、兒童等，覆蓋的服務包括門診、住院、精神疾病服務、預防服務和藥物治療等。② 成本分攤政策帶來的影響包括：從全面付費到成本分攤政策，提高了發展中國家參保人群衛生服務利用的可及性，并在一定程度上減輕了其經濟負擔；發達國家實施從全免費到成本分攤政策，在一定程度上減少了衛生服務過度利用，但沒有降低項目成本，并且基本衛生服務利用或者基本藥物依從性的降低卻帶來了一些不良影響。

引用本文： 賈莉英,袁蓓蓓,楊冰一,張國杰,常捷,于海寧,趙世超,孟慶躍. 成本分攤機制的引入對參保人群影響的系統評價. 中國循證醫學雜志, 2012, 12(2): 129-141. doi: 10.7507/1672-2531.20120023 復制

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1. 1 Manning WG, Marquis MS. Health insurance: the tradeoff between risk pooling and moral hazard. J Health Econ , 1996, 15(5): 609-639.
2. Manning WG, Newhouse JP, Duan N, et al . Health insurance and the demand for medical care: evidence from a randomized experiment. Am Econ Rev , 1987, 77(3): 251-277.
3. Newhouse JP, Manning WG, Morris CN, et al . Some interim results from a controlled trial of cost sharing in health insurance. N Engl J Med , 1981, 305(25): 1501-1507.
4. Kim J, Ko S, Yang B. The effects of patient cost sharing on ambulatory utilization in South Korea. Health Policy , 2005, 72(3): 293-300.
5. van Gool K, Savage E, Viney R, et al . Catastrophic insurance: Impact of the Australian Medicare Safety Net on fees, service use and out-of-pocket costs. CHERE, University of Technology, Sydney, 2006.
6. Grootendorst PV, Marshall JK, Holbrook AM, et al . The Impact of Differential Cost Sharing of Non-Steroidal Anti-Inflammatory Agents on the Use and Costs of Analgesic Drugs. 2004, McMaster University.
7. Wang PS, Patrick AR, Dormuth CR, et al . The impact of cost sharing on antidepressant use among older adults in British Columbia. Psychiatr Serv , 2008, 59(4): 377-383.
8. Anis AH, Guh DP, Lacaille D, et al . When patients have to pay a share of drug costs: effects on frequency of physician visits, hospital admissions and filling of prescriptions. CMAJ , 2005, 173(11): 1335-1340.
9. Wang PS, Patrick AR, Dormuth C, et al . Impact of drug cost sharing on service use and adverse clinical outcomes in elderly receiving antidepressants. J Ment Health Policy Econ , 2010, 13(1): 37-44.
10. Dormuth CR, Glynn RJ, Neumann P, et al . Impact of two sequential drug cost-sharing policies on the use of inhaled medications in older patients with chronic obstructive pulmonary disease or asthma. Clin Ther , 2006, 28(6): 964-978.
11. Schneeweiss S, Patrick AR, Maclure M, et al . Adherence to statin therapy under drug cost sharing in patients with and without acute myocardial infarction: a population-based natural experiment. Circulation , 2007, 115(16): 2128-2135.
12. Tamblyn R, Laprise R, Hanley JA, et al . Adverse events associated with prescription drug cost-sharing among poor and elderly persons. JAMA , 2001, 285(4): 421-429.
13. Dormuth CR, Neumann P, Maclure M, et al . Effects of prescription coinsurance and income-based deductibles on net health plan spending for older users of inhaled medications. Med Care , 2009, 47(5): 508-516.
14. Blais L, Couture J, Rahme E, et al . Impact of a cost sharing drug insurance plan on drug utilization among individuals receiving social assistance. Health Policy , 2003, 64(2): 163-172.
15. Sun X, Jackson S, Carmichael G, et al . Catastrophic medical payment and financial protection in rural China: evidence from the New Cooperative Medical Scheme in Shandong Province. Health Econ , 2009, 18(1): 103-119.
16. Ruiz F, Amaya L, Venegas S. Progressive segmented health insurance: Colombian health reform and access to health services. Health Econ , 2007, 16(1): 3-18.
17. Grignon M, Perronnin M, Lavis JN. Does free complementary health insurance help the poor to access health care? Evidence from France. Health Econ , 2008, 17(2): 203-219.
18. Farbmacher H. Copayments for doctor visits in Germany and the probability of visiting a physician - Evidence from a natural experiment. 2009, University of Munich, Department of Economics.
19. Augurzky B, Bauer TK, Schaffner S, Copayments in the German health system-Do they work. RWI: Discussion Papers, 2006.
20. Schmitz H. Do Optional Deductibles Reduce the Number of Doctor Visits? Empirical Evidence with German Data. Ruhr Graduate School in Economics (RGS Econ) and University of Duisburg-Essen, 2008.
21. Pütz C, Hagist C. Optional deductibles in social health insurance systems: findings from Germany. Eur J Health Econ , 2006, 7(4): 225-230.
22. Schreyögg J, Grabka MM. Copayments for ambulatory care in Germany: a natural experiment using a difference-in-difference approach. Eur J Health Econ , 2010, 11(3): 331-341.
23. Schmitt J, Kirch W, Meurer M. Effects of the introduction of the German "Praxisgebühr" on outpatient care and treatment of patients with atopic eczema. J Dtsch Dermatol Ges , 2009, 7(10): 879-886.
24. Huber CA, Rüesch P, Mielck A, et al . Effects of cost sharing on seeking outpatient care: a propensity-matched study in Germany and Switzerland. J Eval Clin Pract, 2011, doi: 10.1111/j.1365-2753.2011.01679.x. [Epub ahead of print].
25. Devadasan N, Criel B, Van Damme W, et al . Community health insurance in Gudalur, India, increases access to hospital care. Health Policy Plan , 2010, 25(2): 145-154.
26. Vardy DA, Freud T, Shvartzman P, et al . Introducing co-payment for consultant specialist services. Isr Med Assoc J , 2006, 8(8): 558-562.
27. Fiorio CV, Siciliani L. Co-payments and the demand for pharmaceuticals: Evidence from Italy. Economic Modelling , 2010, 27(4): 835-841.
28. Tracy J. Case study 6. Mobilizing resources for health: the first phase of Kyrgyzstan's co-payment policy. Health systems confront poverty, edited by Erio Ziglio, Rogerio Barbosa, Yves Charpak, Steve Turner, 2003: 79-92.
29. Schneider P, Hanson K. Horizontal equity in utilisation of care and fairness of health financing: a comparison of micro-health insurance and user fees in Rwanda. Health Econ , 2006, 15(1): 19-31.
30. Saksena P, Antunes AF, Xu K, et al . Mutual health insurance in Rwanda: evidence on access to care and financial risk protection. Health Policy , 2011, 99(3): 203-209.
31. Schellhorn M. The effect of variable health insurance deductibles on the demand for physician visits. Health Econ , 2001, 10(5): 441-456.
32. Chen CS, Liu TC, Lin HC, et al . The effect of Taiwan's National Health Insurance on infants' preventive care use and inpatient care use. Health Policy , 2007, 80(3): 432-443. 33 Cheng SH, Chiang TL. The effect of universal health insurance on health care utilization in Taiwan. Results from a natural experiment. JAMA , 1997, 278(2): 89-93.
33. Chu HL, Liu SZ, Romeis JC. The Effects of Physicians’Financial Incentives on the Effectiveness of Taiwan's Outpatient Drug Copayment Policy. Drug Information Journal , 2008, 42: 493-502.
34. Liu SZ, Romeis JC. Assessing the effect of Taiwan's outpatient prescription drug copayment policy in the elderly. Med Care , 2003, 41(12): 1331-1342.
35. Lu JF, Hsiao WC. Does universal health insurance make health care unaffordable? Lessons from Taiwan. Health Aff (Millwood) , 2003, 22(3): 77-88.
36. Kipp W, Kamugisha J, Jacobs P, et al . User fees, health staff incentives, and service utilization in Kabarole District, Uganda. Bull World Health Organ , 2001, 79(11): 1032-1037.
37. Burnham GM, Pariyo G, Galiwango E, et al . Discontinuation of cost sharing in Uganda. Bull World Health Organ , 2004, 82(3): 187-195.
38. Selby JV, Fireman BH, Swain BE. Effect of a copayment on use of the emergency department in a health maintenance organization. N Engl J Med , 1996, 334(10): 635-641.
39. Phelps CE, Newhouse JP. Effect of coinsurance: A multivariate analysis. Bulletin of the World Health Organization, 1972.
40. Trivedi AN, Rakowski W, Ayanian JZ. Effect of cost sharing on screening mammography in Medicare health plans. N Engl J Med , 2008, 358(4): 375-383.
41. Hayami DE, Freeborn DK. Effect of coverage on use of an HMO alcoholism treatment program, outcome, and medical care utilization. Am J Public Health , 1981, 71(10): 1133-1143.
42. Roblin DW, Platt R, Goodman MJ, et al . Effect of increased cost-sharing on oral hypoglycemic use in five managed care organizations: how much is too much? Med Care , 2005, 43(10): 951-959.
43. Wong MD, Andersen R, Sherbourne CD, et al . Effects of cost sharing on care seeking and health status: results from the Medical Outcomes Study. Am J Public Health , 2001, 91(11): 1889-1894.
44. Wharam JF, Landon BE, Galbraith AA, et al . Emergency department use and subsequent hospitalizations among members of a high-deductible health plan. JAMA , 2007, 297(10): 1093-1102.
45. Lowe RA, Fu R, Gallia CA. Impact of policy changes on emergency department use by Medicaid enrollees in Oregon. Med Care , 2010, 48(7): 619-627.
46. Simon GE, Grothaus L, Durham ML, et al . Impact of visit copayments on outpatient mental health utilization by members of a health maintenance organization. Am J Psychiatry , 1996, 153(3): 331-338.
47. Wallen J, Roddy P, Meyers SM. Male-female differences in mental health visits under cost-sharing. Health Serv Res , 1986, 21(2 Pt 2): 341-350.
48. Harris BL, Stergachis A, Ried LD, The effect of drug co-payments on utilization and cost of pharmaceuticals in a health maintenance organization. Medical Care , 1990, 28(10): 907-917.
49. Guy GP Jr. The effects of cost sharing on access to care among childless adults. Health Serv Res , 2010, 45(6 Pt 1): 1720-1739.
50. Fischer PJ, Strobino DM, Pinckney CA. Utilization of child health clinics following introduction of a copayment. Am J Public Health , 1984, 74(12): 1401-1403.
51. Hsu J, Price M, Brand R, et al . Cost-sharing for emergency care and unfavorable clinical events: findings from the safety and financial ramifications of ED copayments study. Health Serv Res , 2006, 41(5): 1801-1820.
52. Reeder CE, Nelson AA. The differential impact of copayment on drug use in a Medicaid population. Inquiry , 1985, 22(4): 396-403.
53. Reed M, Fung V, Brand R, et al . Care-seeking behavior in response to emergency department copayments. Med Care , 2005, 43(8): 810-816.
54. Newhouse JP. Cost Sharing for Medical Care Services. The Rand Corporation, 1984.
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《中國循證醫學雜志》

成本分攤機制的引入對參保人群影響的系統評價

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《中國循證醫學雜志》

成本分攤機制的引入對參保人群影響的系統評價

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