BMC Health Services Research最新文献

Background: Ensuring equitable access to healthcare under universal health coverage is critical; however, the financial sustainability of public health insurance systems faces challenges in aging societies. The present study aimed to evaluate the impact of the 2022 cost-sharing reform to increase coinsurance rate on outpatient care utilization among older adults with relatively high income, and to estimate the price elasticity of demand for outpatient care in response to the cost-sharing increase.

Methods: Employing a quasi-experimental design, this cohort study treats the 2022 cost-sharing reform as a natural intervention. Data were drawn from medical claims covering individuals aged ≥75 years enrolled in the Latter-Stage Elderly Healthcare System in several Japanese prefectures. Participants included 22,013 individuals in the intervention group (coinsurance increased from 10% to 20%) and 104,461 in the control group (coinsurance remained at 10%), observed from October 1, 2021, to September 30, 2023. An increase in coinsurance rate from 10% to 20% implemented on October 1, 2022, was treated as an exposure variable. Monthly total expenditures on outpatient care-physician visits, prescriptions, and dental visits-served as primary outcomes. Changes in total expenditure post-reform were assessed using controlled interrupted time series analysis, fitting a log-gamma regression model. Relative ratios (RRs) and 95% confidence intervals were estimated, and price elasticities were calculated using the change in out-of-pocket expenditures as denominators.

Results: Average total expenditures for overall outpatient care among the intervention group pre- and post-reform were ¥31,468 (SD=¥53,072) and ¥31,607 (SD=¥57,897) per month, respectively. Following the reform, expenditures significantly decreased for physician visits (RR=0.92 [0.90-0.94]) and prescriptions (RR=0.95 [0.93-0.97]) immediately after the reform, while dental visit expenditures did not significantly change (RR=0.97 [0.93-1.01]). Calculated price elasticities were highly inelastic (-0.137, -0.079, and -0.047 for physician visits, prescriptions, and dental visits, respectively).

Conclusions: These findings suggest that increasing the coinsurance rate led to modest short-term reductions in outpatient care expenditures among older adults with relatively high incomes. Outpatient care demand was largely inelastic to price changes, supporting the potential for income-based cost-sharing policies to enhance the financial sustainability of public health insurance systems with limited reduction in access.

Background: Medical councils and associations frequently stress the importance of professionalism, yet unprofessional behaviors remain common. Such behaviors can compromise patient safety, especially in emergency departments, which face diverse conditions, heavy workloads, and demanding team interactions. Therefore, the present study aimed to investigate the incidence, pattern, and factors associated with unprofessional behavior experienced by emergency physicians in a developing country.

Methods: In this convergent parallel mixed-methods study, a nationwide online survey of emergency physicians and residents was conducted alongside in-depth interviews with residents and specialists from emergency medicine and other specialties between November 5 and December 5, 2024.

Results: Among 262 respondents (response rate: 40.3%), the majority were board-certified physicians (71.4%), were female (58.8%), and had 1-10 years of experience (81.7%). Approximately 90.8% of participants reported experiencing unprofessional behavior in the emergency departments during the past year. In particular, verbal aggression (85.9%) had the highest frequency, followed by online misconduct (33.6%) and physical aggression (7.6%). Younger physicians (< 35 years of age), those with 1-10 years of experience, and those who were dissatisfied with their income were more likely to encounter such behavior than others. Most incidents of unprofessional behavior occurred during consultations or patient handovers, with surgery and internal medicine specialists most commonly identified as perpetrators. Although most hospitals had reporting systems, less than half of the incidents were reported, mainly because of low perceived severity and lack of effective resolution. The reported consequences included reduced job satisfaction (67.2%), decreased professional confidence (46.2%), and negative effects on patient safety and outcomes (27.3%), including compromised clinical decision-making. The qualitative findings revealed that unprofessional behavior is often normalized in emergency departments, driven by high workload and inadequate communication. Concerns regarding clinical competency among emergency physicians and residents also emerged as a contributing factor.

Conclusions: Unprofessional behavior is widespread in Thai emergency medicine, which disproportionately affects younger physicians and undermines provider well-being and patient care. The results highlight not only individual challenges but also systemic gaps within the healthcare system. Thus, urgent, multilevel strategies are needed to address this issue and improve patient safety.