The effects of elderly healthcare vouchers on public services utilisation: Administrative data analysis from 2009-2015

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Abstract Summary
Abstract ID :
Submission Type
Authors (including presenting author) :
Yam CHK, Chong MKC, Chow TY, Fung VLH, Wong ELY, Griffiths SM, Yeoh EK
Affiliation :
The Jockey Club of School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong
Introduction :
Vouchers are a demand-side subsidy to reduce financial hardship and improve quality and efficiency. Evidence demonstrated voucher is effective in encouraging people to perform clearly defined, time-limited and simple behavioural tasks. To reduce reliance on public healthcare services, Elderly Healthcare Voucher Scheme has been introduced by the Hong Kong Government since 2009 to provide subsidy to elderly persons to visit ten different types of private primary care providers for curative, preventive and chronic disease management.
Objectives :
This study aimed to assess whether voucher use is associated with a reduction in the public services utilisation from 2009-2015, as part of the Evaluation Study of Voucher Scheme.
Methodology :
A questionnaire survey was conducted in 2016 among 974 elderly persons eligible for the Voucher Scheme recruited at different sites to better represent the elderly population. Consent was obtained from the respondents to obtain their public services utilisation and voucher utilisation data from Hospital Authority and Department of Health respectively from 2009-2015. Public services utilization included General Outpatient Clinics (GOPCs) and Accident & Emergency Department (A&E). Time trends of public services utilisation between those who used vouchers for consulting private Western medical doctors and those who did not were analysed over time. Multivariate analyses were also conducted to assess the associations between public services utilisation and voucher use in 2015.
Result & Outcome :
Elderly persons mainly used vouchers for acute episodic conditions (78.2%), while the voucher use for preventive services (5.0%) and chronic disease management (16.8%) was relatively low in 2015. There were no significant differences in GOPC and A&E attendances in each year between voucher and non-voucher users. Logistic regression further showed that voucher use for seeing Western medicine doctors did not relate to GOPC attendances in 2015. Social security assistance recipient (OR: 1.85; CI: 1.13-3.00) and presence of chronic diseases (OR: 2.69; CI: 1.87-3.87) were positively related to GOPC attendance. Our findings suggested that voucher might not be effective in reducing the demand of public services utilisation due to the untargeted nature of services in the voucher design. There needs a re-design of the Voucher Scheme to meet the policy objectives of encouraging preventive services, enabling chronic disease management, and reducing public services utilisation.
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