Health Policy Manag.  2017 Jun;27(2):128-138. 10.4332/KJHPA.2017.27.2.128.

An Analysis of Effects of Differential Coinsurance Policy and Utilization of Outpatients Care by Types of Medical Institutions

  • 1Research Institute for Healthcare Policy, Korean Medical Association, Seoul, Korea.
  • 2Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.


The purpose of this study is to analyze the effects of differential coinsurance policy on prescription drug coverage of outpatients by types of medical institutions.
In this study, we used a sample cohort database of the National Health Insurance Service and frequency analysis and marginal logistic regression model using generalized estimating equation were used for statistical analysis.
The summary on the major research is followed. First, about 16% of patients who used only tertiary or general hospital due to 52 ambulatory care sensitive conditions before policy implementation moved to hospitals and clinics. However, about 57% of them still use tertiary or general hospital. Second, the factors influencing the utilization of hospitals and clinics after the implementation of the policy were gender, age, and income level. As a result, the policy is effective to reduce the medical use of outpatient mental patients in tertiary or general hospital, but the effect is not significant.
Therefore, in order to achieve the purpose of the policy for establishing the health care delivery system, it is necessary to adjust the co-payment so as to feel the burden on the co-payment when the outpatient for 52 ambulatory care sensitive conditions is used at the tertiary or general hospital.


Outpatients; 52 ambulatory care sensitive conditions; Differential coinsurance policy; Prescription drug coverage; Health care delivery system
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