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护士就诊共付对基层医疗利用的影响:低收入家庭是否付出代价?

Effects of nurse visit copayment on primary care use: Do low-income households pay the price?
Journal of Health Economics · 2024 · Haaga, Tapio、Böckerman, Petri、Kortelainen, Mika、Tukiainen, Janne

中文摘要

护士越来越多地提供基层医疗服务,然而关于费用分担的文献对护士就诊关注甚少。我们采用交错双重差分设计,考察对护士就诊实行10欧元共付对芬兰成年人公共基层医疗利用的影响。我们发现,在一年的随访期内,共付使护士就诊减少了9%–10%。以绝对量衡量存在按收入的异质性,但以相对量衡量则不存在。对全科医生(GP)利用的溢出效应为负但较小,统计显著性不一。我们还分析了随后在全国范围内取消该共付的情况。然而,由于平行趋势假设缺乏可信性,我们不对其得出因果结论。总体而言,我们的分析表明,适度的共付可能对低收入个体获得医疗服务构成更大的障碍。我们还提供了一个将预分析计划用于回顾性观察数据的示例。

Abstract

Nurses are increasingly providing primary care, yet the literature on cost-sharing has paid little attention to nurse visits. We employ a staggered difference-in-differences design to examine the effects of adopting a 10-euro copayment for nurse visits on the use of public primary care among Finnish adults. We find that the copayment reduced nurse visits by 9%–10% during a one-year follow-up. There is heterogeneity by income in absolute terms, but not in relative terms. The spillover effects on general practitioner (GP) use are negative but small, with varying statistical significance. We also analyze the subsequent nationwide abolition of the copayment. However, we refrain from drawing causal conclusions from this due to the lack of credibility in the parallel trends assumption. Overall, our analysis suggests that moderate copayments can create a greater barrier to access for low-income individuals. We also provide an example of using a pre-analysis plan for retrospective observational data.
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