Patient charges mean young people visit doctor less

"It's interesting that, despite relatively low charges, we find a fall in the number of physician visits," says Naimi Johansson. A PhD student in health economics, Johansson is the first author of the research study, published in the European Journal of Health Economics.

This study involved an assessment of the impact on primary care medical consultations in the Västra Götaland region, in southwest Sweden, of young adults leaving cost-free care when, starting on their 20th birthday, they need to pay a co-payment of SEK 100 for every visit.

The study was based on an analysis of register data from the Västra Götaland region and Statistics Sweden, including particulars of some 73,000 individuals aged 18-22.

The results show that 19-year-old women visit primary care facilities, on average, 1.41 times a year, and that most of these visits are made a relatively short time before their 20th birthday. As 20-year-olds, they visit 1.32 times a year on average. Precisely at the transition date, a marked fall takes place in the group, with 9.2 percent fewer consultations.

Men conform to the same pattern but with a lower frequency: 0.86 primary care physician visits annually as 19-year-olds and 0.81 as 20-year-olds. The change at the 20-year point, minus 3.5 percent, is not statistically significant.

The study confirms previous research in the field showing that patient charges reduce people's use of health care to some degree. Nevertheless, the study is unusually clear in demonstrating how price sensitivity in health care can be linked to income level.

The current study refers to four income categories. When one have to pay the co-payment, women with the lowest incomes prove to be the group whose frequency of visits to doctors in primary care falls most: by 14.0 percent. For men in the lowest income category, the decrease is 9.8 percent.

"It's important to point out that, in this research, we haven't been able to study what type of visits is declining after the 20th birthday. Patient out-of-pocket prices exist, to some extent, to discourage visits that are relatively unnecessary," Johansson says.

Her research at Sahlgrenska Academy, University of Gothenburg, focuses on exactly how patient out-of-pocket prices affect use of health care in Sweden and how health care utilization differs among geographical areas.

Patient out-of-pocket prices are part of the health care system, but regulations and levels vary from one region to another in Sweden. In view of the great volume of resources devoted to health care, it is vital to understand how the health care system impacts on how people use it and, by extension, on their health, Johansson thinks.