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Impact of reduced copayments on GP access for injuries

Impact of reduced copayments on GP access for injuries. Presentation to 5 th Health Services & Policy Research Conference. Jean-Pierre de Raad & John Stephenson, NZIER December 2007. Evaluation objectives. To what extent would an increase in ACC’s subsidy to general practitioners lead to:

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Impact of reduced copayments on GP access for injuries

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  1. Impact of reduced copayments on GP access for injuries Presentation to 5th Health Services & Policy Research Conference Jean-Pierre de Raad & John Stephenson, NZIER December 2007

  2. Evaluation objectives • To what extent would an increase in ACC’s subsidy to general practitioners lead to: • reduced copayments for claimants, and thus… • an increase in utilisation, particularly by Māori, Pacific people, and people with low socioeconomic status.

  3. Intervention • Increase in subsidies to providers in pilot sites for 1 year • Whangarei, Rotorua, Wanganui, Wellington, Nelson, Dunedin • Letter with expectation that subsidies be passed on • Minimal awareness-raising

  4. Methods • Compare impact vs rest of NZ • Copayment surveys 2004-06 • Focus groups with participating GPs • Public awareness surveys • Time-series and panel-data analyses of ACC claims (1.4m observations per annum x 4 years)

  5. Evidence from copayment surveys Dollars per visit • No evidence that extra $6 reduced copayments • Pilot sites: $7.50 of extra $10 passed on (+/- $2.50) • Copayments down 41% • Analysis by PHO-type inconclusive 2004 2005

  6. Utilisation – evidence from GP focus groups • not necessarily more patients, but patients come back more • not aware of more utilisation by target groups • extra money and repeat visits allows better service and better outcomes

  7. Utilisation – time series results

  8. Utilisation – panel data results

  9. Pilot sites Non-pilot sites $GP $Other $ GP $Other Substitution effects • GP-initiated claims up 4.5%, but claims initiated at other treatment providers down: net effect on claims +1.4%? • Similar story looking at costs (below) or conditional probabilities of use of different providers

  10. Conclusions & policy relevance • User charges reduced, and utilisation up a bit: • Claims up, fewer visits per claim • Inelastic demand (0.1 is low cf international literature) • Mixed evidence on target group impact • Extra visits for less serious injuries, i.e. lower benefits • Income transfers dominate • Focus groups find opposite on utilisation • Not instrument of choice to address ‘unmet need’

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