Publishing type：Research paper (scientific journal)   Publisher：BMJ  

Objectives

To investigate the impact of no cost sharing on paediatric care on usage and health outcomes, and whether the effect varies by household income levels.

Design

Regression discontinuity design.

Setting

Nationwide medical claims database in Japan.

Participants

Children aged younger than 20 years from April 2018 to March 2022.

Exposure

Co-insurance rate that increases sharply from 0% to 30% at a certain age threshold (the threshold age varies between 6 and 20 years depending on region).

Primary outcome measures

The outpatient care usage (outpatient visit days and healthcare spending for outpatient care) and inpatient care (experience of any hospitalisation and healthcare spending for inpatient care).

Results

Of 244 549 children, 49 556 participants were in the bandwidth and thus included in our analyses. Results from the regression discontinuity analysis indicate that no cost sharing was associated with a significant increase in the number of outpatient visit days (+5.26 days; 95% CI, +4.89 to +5.82; p<0.01; estimated arc price elasticity, −0.45) and in outpatient healthcare spending (+US$369; 95% CI, +US$344 to +US$406; p<0.01; arc price elasticity, −0.55). We found no evidence that no cost sharing was associated with changes in inpatient care usage. Notably, the effect of no cost-sharing policy on outpatient healthcare usage was larger among children from high-income households (visit days +5.96 days; 95% CI, +4.88 to +7.64, spending +US$511; 95% CI, +US$440 to +US$627) compared with children from low-income households (visit days +2.64 days; 95% CI, +1.54 to +4.23, spending +US$154; 95% CI, +US$80 to +US$249).

Conclusions

No cost sharing for paediatric care was associated with a greater usage of outpatient care services, but did not affect inpatient care usage. The study found that this effect was more pronounced among children from high-income households, indicating that the no cost sharing disproportionately benefits high-income households and may contribute to larger disparities.

DOI： 10.1136/bmjopen-2023-071976

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

<title>Abstract</title>Despite rapidly rising health expenditure associated with population aging, empirical evidence on the effects of cost-sharing on older people is still limited. This study estimated the effects of cost-sharing on the utilization of healthcare and health among older people, the most intensive users of healthcare. We employed a regression discontinuity design by exploiting a drastic reduction in the coinsurance rate from 30 to 10% at age 70 in Japan. We used large administrative claims data as well as income information at the individual level provided by a municipality. Using the claims data with 1,420,252 person-month observations for health expenditure, we found that reduced cost-sharing modestly increased outpatient expenditure, with an implied price elasticity of  – 0.07. When examining the effects of reduced cost-sharing by income, we found that the price elasticities for outpatient expenditure were almost zero,  – 0.08, and  – 0.11 for lower-, middle-, and higher-income individuals, respectively, suggesting that lower-income individuals do not have more elastic demand for outpatient care compared with other income groups. Using large-scale mail survey data with 3404 observations for self-reported health, we found that the cost-sharing reduction significantly improved self-reported health only among lower-income individuals, but drawing clear conclusions about health outcomes is difficult because of a lack of strong graphical evidence to support health improvement. Our results suggest that varying cost-sharing by income for older people (i.e., smaller cost-sharing for lower-income individuals and larger cost-sharing for higher-income individuals) may reduce health expenditure without compromising health.

DOI： 10.1007/s10198-021-01399-6

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Other Link： https://link.springer.com/article/10.1007/s10198-021-01399-6/fulltext.html

Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：American Medical Association (AMA)  

DOI： 10.1001/jamainternmed.2021.5247

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

<title>Abstract</title><sec>
<title>Background</title>
A study has shown that industry payments to physicians for drugs are associated not only with higher drug prescriptions but also with higher non-drug costs due to additional utilization of healthcare services. However, the association between industry payments to cardiologists for antiplatelet drugs and the costs and number of percutaneous coronary interventions they perform has not been investigated.


</sec><sec>
<title>Objective</title>
To examine the association between industry payments to cardiologists for antiplatelet drugs and the costs and number of percutaneous coronary interventions they perform.


</sec><sec>
<title>Design</title>
Using the 2016 Open Payments Database linked to the 2017 Medicare Provider Utilization and Payment Data, we examined the association between the value of industry payments related to the antiplatelet drugs prasugrel and ticagrelor and healthcare spending and volume for cardiovascular procedures, adjusted for potential cofounders.


</sec><sec>
<title>Subjects</title>
A total of 7456 cardiologists who performed diagnostic cardiac catheterizations on Medicare beneficiaries in 2017.


</sec><sec>
<title>Main Measures</title>
Primary outcomes included (1) healthcare spending on cardiac procedures, (2) diagnostic cardiac catheterization volumes, and (3) rates of coronary stenting. Secondary outcomes were total expenditures for all drugs and for antiplatelet drugs.


</sec><sec>
<title>Key Results</title>
Industry payments for antiplatelet drugs were associated with higher healthcare spending on cardiac procedures (adjusted difference, +$50.9 for additional $100 industry payments; 95% CI, +$25.5 to +$76.2; P &lt; 0.001), diagnostic cardiac catheterizations (+0.1 procedures per cardiologist; 95% CI, +0.03 to +0.1; P=0.001), and stent use (+0.5 per 1000 diagnostic cardiac catheterizations per cardiologist; 95% CI, +0.2 to +0.9; P=0.002). Industry payments for antiplatelet drugs were associated with higher total costs for all drugs and antiplatelet drugs.


</sec><sec>
<title>Conclusions</title>
Industry payments to cardiologists for antiplatelet drugs were associated with both prescribing of antiplatelet drugs and the use of cardiac procedures and stents. Further research is warranted to understand whether the observed associations are causal or reflect a greater propensity for higher volume proceduralists to have relationships with industry.


</sec>

DOI： 10.1007/s11606-021-06980-6

PubMed

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Other Link： https://link.springer.com/article/10.1007/s11606-021-06980-6/fulltext.html

Authorship：Lead author   Publishing type：Research paper (scientific journal)   Publisher：BMJ  

<title>Abstract</title>
<sec>
<title>Objective</title>
To determine whether patient mortality after surgery differs between surgeries performed on surgeons’ birthdays compared with other days of the year.


</sec>
<sec>
<title>Design</title>
Retrospective observational study.


</sec>
<sec>
<title>Setting</title>
US acute care and critical access hospitals.


</sec>
<sec>
<title>Participants</title>
100% fee-for-service Medicare beneficiaries aged 65 to 99 years who underwent one of 17 common emergency surgical procedures in 2011-14.


</sec>
<sec>
<title>Main outcome measures</title>
Patient postoperative 30 day mortality, defined as death within 30 days after surgery, with adjustment for patient characteristics and surgeon fixed effects.


</sec>
<sec>
<title>Results</title>

980 876 procedures performed by 47 489 surgeons were analyzed. 2064 (0.2%) of the procedures were performed on surgeons’ birthdays. Patient characteristics, including severity of illness, were similar between patients who underwent surgery on a surgeon’s birthday and those who underwent surgery on other days. The overall unadjusted 30 day mortality on the operating surgeon’s birthday was 7.0% (145/2064) and that on other days was 5.6% (54 824/978 812). After adjusting for patient characteristics and surgeon fixed effects (effectively comparing outcomes of patients treated by the same surgeon on different days), patients who underwent surgery on a surgeon’s birthday exhibited higher mortality compared with patients who underwent surgery on other days (adjusted mortality rate, 6.9%
<italic>v</italic>
5.6%; adjusted difference 1.3%, 95% confidence interval 0.1% to 2.5%; P=0.03). Event study analysis of patient mortality by day of surgery relative to a surgeon’s birthday found similar results.



</sec>
<sec>
<title>Conclusions</title>
Among Medicare beneficiaries who underwent common emergency surgeries, those who received surgery on the surgeon’s birthday experienced higher mortality compared with patients who underwent surgery on other days. These findings suggest that surgeons might be distracted by life events that are not directly related to work.


</sec>

DOI： 10.1136/bmj.m4381

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Other Link： https://syndication.highwire.org/content/doi/10.1136/bmj.m4381

Language：English   Publishing type：Research paper (scientific journal)   Publisher：SAGE Publications  

DOI： 10.1177/0022034520946022

Scopus

PubMed

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Other Link： http://journals.sagepub.com/doi/full-xml/10.1177/0022034520946022

Language：English   Publishing type：Research paper (scientific journal)   Publisher：American Medical Association (AMA)  

DOI： 10.1001/jamanetworkopen.2019.18681

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s11606-019-05368-x

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1136/bmjopen-2018-024439

Web of Science

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s13561-017-0165-3

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Language：English   Presentation type：Poster presentation  

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