Abstrato

Cancellation of Exemption from Medical Fees.

Engelchin-Nissan E, Kokia E, Tsamir J, Kertes J

Background: The collection of medical fees is an effective way of reducing costs in health systems. This deductible increases the price per unit per insured from zero to the deductible level, thereby reducing the quantity requested and reducing the moral risk. The deductible raises serious concerns that are described in the professional literature and are more disturbing in public health systems based on justice and fairness, such as the Israeli one introduced in 1995. In 2003 there was a change in the definition of policyholders entitled to exemption from medical fees.

The aims of the study: Estimation of the change in the consumption of medical services for individuals whose eligibility for exemption has been changed.

Populations and samples: The study population was divided into three sub-populations: Stop receiving the benefit, continue to receive the benefit and Control group: Members who did not have an economic benefit during the entire study period.

Data analysis: 1. Comparison of the average visits before and after was examined using a T-test.

2. In the multivariate model, we used a Poisson hierarchical model, GEE*, because of repeated measurements for each patient, while monitoring the variables: gender, age, sector, health status, and SES.

3. The comparison of the average cost was performed using a variance analysis and the post hoc tests between the three groups were corrected according to Scheffe.

Results: The results are very sharp in their significance. In both control groups, those who continued the exemption and those who had never been exempted from service consumption increased. In contrast, the consumption of medical services for policyholders for whom the exemption was discontinued decreased.

Conclusion: The enactment of the National Health Insurance Law in 1995 was a dramatic social statement by the government, which took responsibility for providing medical care to the general public, regardless of the economic ability of the patients. The law included very important statements about an ideal society, and at the outset defined it as based on justice, equality and mutual aid. Despite the promises embodied in the law, its full implementation and principles were not fully realized and the collection of medical fees is an example. The law included very important statements about an ideal society, and at the outset defined it as based on justice, equality and mutual aid. Despite the promises embodied in the law, its full implementation and principles were not fully realized and the collection of medical fees is an example.