La contribución del usuario al coste de los servicios médicos puede aumentar la mortalidad en adultos: evidencia de Colombia

If you like research in evaluation of health policies and services, you like to participate in an IMMO event, with good roll, constructive; scam Juniors, sirs, semi-jun EITHER semi -harmonyAssistance professionals, personal researcher, physical, economists, social workers and motivated and motivated psychologists, and with many science -applied, good and transferable -then you have to read this entry so well narrated by Marcos and Laia on the table Evaluation of the evaluation of the months of the months of the tables. AES Conference, and then register at the XIV Workshop Evaluaes that will be held on May 9 at the Marqués de Valdecilla University Hospital. It can’t be that Marcos and Laia do not Put the long teeth to attend the highest. If you doubt, take a look at the XIV program Evaluaes Workshop we wait for you in Santander!

Evaluaes Group Work Committee

Work resumes, presented by Marcos Vera-Hernández:

Should users assume part of the cost of the health services they use? This question generates diverse opinions and, often, passionate. One of the most categorical responses came from Bevan Aneurin, the British Minister of Health responsible for the creation of the National Health Service. Just two years after this historical achievement, Bevan resigned in protest when the Minister of Economics insisted on introducing co -suppos for medications and some other services that were even in the entrence were complete screaming.

If the contribution of the users to the cost of the high health services, their capacity to consume other goods and services will be affected every time they do, since they must allocate, part of the sinks to cover such costs. On the contrary, if the contribution is too low, there is a risk that some users abuse the system and make excessive use of health services. A doctor told me to recierse his frustration for having to attend complaces derived from the Piercings.

In my present at the Evaluaes table I seek contribute evidence on this issue, focusing on whether a greater contribution to the cost of health services affects the health of the adult population. It is a relief research question, but difficult to answer. This because the effects of changes in co -payment (or other forms of participation in the cost of medical services) no immediate child. A temporary, special metal lag, great poverty, which makes it printed on a prolonged one.

In addition, following the best tradition of Evaluaes, it is not enough to compare the health levels between those who anticipate high co -payment and those to low co -payment. It would be an exceptional coincidence that the only difference between the two groups was the level of the copayment, so direct comparison would not allow the effect of co -payment of other factors that can also influence health.

Colombia came to the rescue: its data and characteristics of the health system provided us with what we need to do the study. The databases in Colombia the registration of the use of health services (ambulatory, secondary and tertiary, as well as medicines) of the workers of the formal sector, that is, of those who have contribution and are discharged in the social follow -up system. They also allow the worker to be laid throughout the tió. For this study, the authors, Javier Amaya, Giancarlo Buitrago, Grant Miller And we use databases from 2011 to 2019.

As for how we managed to isolate the effect of co -payment of other differences that may exist between high and bass co -payment groups, we take advantage of the fact that there is an abrupt change in the copayment level according to the deltizer work. The copayment is equivalent to 46% of the daily minimum salary for workers whose labor income ranges from two five minimum salary. For what they receive more than five monthly, the co -payment aumn to 122% of the daily minimum salary. This grouping variation in the Copage the application of the discontinuous regression ethical, which allows us to isolate the effect of the formation of other differences that may extend these two groups of people.

It is not a standard application of this technique because the level of copayment is not fixed for each individual, but also changes in time according to its laboratory rent. In addition, you can be awaken and decrease in short periods of time. Resolving this took us a long time. We begin with trying to apply our own adaptation of the model are a discontinuous regression stratid. In fact, we advance a lot with this adaptation, until we realized that they exist The article De Cellini, Ferreira and Rothstein, published in 2010, which provides an ideal solution for our case.

Already focusing on the results, Figure 1 illustrates how the use of medical consultations varies when a high copayment is maintained for a prolonged period. Our estimates indicate that, after 36 months of high copayment, patients have an average of 0.4 consultations less than those subjects to a low copayment. However, after 96 months, the difference is reduced a little more than 0.1 consultations. What should be decreased in the long -term gap? Explanation A possible escape of the reduction in medical care ends up affecting health, which eventually increases the demand for consultations.

Figure 1. Effect of high copayment on doctors visits.

Figure 2 Teacher that, after 66 months of a high copayment, the use of Hospital Intensive Care Services is the mayor compared to a low copayment scenario. This results pattern is consistent with the hypothesis that a high co -payment affects negative health status of patients by a challenge in receiving timely attitude, carrying a mayor of the Un NO, the need for care in intensive care.

Figure 2. Effect of high copayment in the use of intensive care.

Figure 3 reveals that the high co -payment incents mortality respect for the minor co -payment, with an effect that becomes a significant statistical statistical of 80 months. In quantitations, this increase is equivalent to 4 deaths per 10,000 people. Similar results are obtained by using a survival model of Weibullin which a polynomial is incorporated into the work ingeso to maintain the logic of discontinuous regrying analysis.

Figure 3. Effect of copayment in mortality.

In summary, our study indicates that a co -payment of 122% of the daily minimum wage in Colombia, compared to one of 46%, reduces the frequency of medical consultations, which shows significant implications on health. In particular, we observe an increase in the use of intensive care and in mortality a long term, probably because the least assistance to consultations prevents the early detection of ciierta diseases.

It is important to dismiss that we find us do not imply that any copayment deteriorates health, since the study only compares two species. In addition, the elevated child analyzed copagos and apply to each type of outpatient service – consultations, medications, laboratory tests and diagnostic images – Which means that a patient who requires the Curorus Servicos should pay copper copagos, which requires patient the Curo Servicos should pay copper co -co -payment, which loads load load load load load load load load.

Laia Maynou comments

The article presented by Marcos Vera-Hernández at the Evaluaes table aims to identify the causal relationship between outpatient co-payment and the risk of mortality in adults in Colombia. After their present, my first comments were to congratulate the authors, since the article is very interesting and their contribution to existing literature is clear.

My observations focused on different aspects of the article. In the introduction, I suggested to emphasize the contribution of the study more from the beginning, explain with mayor detail because Colombia is a relevant study house and provide information on the knowledge of knowledge that the assumption to the copayment. As for the methodology, I highlighted the value of the data used, which allow a very detailed analysis, and suggested to define with mayor precision the operation of the copayment and the groups analyzed. I also plant the question about whether the result of health is estimated only at the time T or if it would be to analyze its impact on the cortomacado and long term.

In relation to the results, I commented Figure 1 and the need to explain the small jump in five minimum salary menu. In addition, I asked how an individual was treated in the analysis that changes the co -payment group throughout the period. Finally, on the album, I suggested to deal with depth the recommendations to this public policy derived from the southern studies.

In short, the article right a relevant and well -fundamental contribute, with the opportunity to improve the clarity of some aspects of methodological and in the connection with the debate of health policies.