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An evaluation of universal vouchers as a demand-side subsidy to change primary care utilization: A retrospective analysis of longitudinal services utilisation and voucher claims data from a survey cohort in Hong Kong

Author

Listed:
  • Yeoh, Eng-Kiong
  • Yam, Carrie H.K.
  • Chong, Ka-Chun
  • Chow, Tsz-Yu
  • Fung, Valerie L.H.
  • Wong, Eliza L.Y.
  • Griffiths, Sian M.

Abstract

To incentivize private primary care utilization and reduce reliance on public healthcare services, Elderly Healthcare Voucher Scheme has been implemented to provide a voucher entitlement to entire older resident population for subsidising their purchase of unspecified primary healthcare services in the private sector. Our study assessed whether voucher usage is associated with reduced utilization of public healthcare services. We retrieved the public healthcare services utilization and voucher transaction data of a survey cohort of 551 participants, who were age eligible for the scheme since 2009, over the period 2009–2015. Our results showed that voucher usage was not associated with reduced utilization of public healthcare services and has encouraged dual utilization of public and private healthcare. It may be due to a generated supply-induced demand and price inflation. The finding suggests the voucher is specifically designed to address the health systems issues to achieve the effective policy objectives. Defining the specific services to be provided and the prices at which they should be offered based on the needs of specified populations is a fundamental design parameter which needs to be incorporated. The alternatives of whether primary care services should be expanded and provided in the public sector or purchased using supply/demand side instruments should be considered taking the context and goals of the health system into account.

Suggested Citation

  • Yeoh, Eng-Kiong & Yam, Carrie H.K. & Chong, Ka-Chun & Chow, Tsz-Yu & Fung, Valerie L.H. & Wong, Eliza L.Y. & Griffiths, Sian M., 2020. "An evaluation of universal vouchers as a demand-side subsidy to change primary care utilization: A retrospective analysis of longitudinal services utilisation and voucher claims data from a survey coh," Health Policy, Elsevier, vol. 124(2), pages 189-198.
    • Handle: RePEc:eee:hepoli:v:124:y:2020:i:2:p:189-198
    DOI: 10.1016/j.healthpol.2019.12.009
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    References listed on IDEAS

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    1. Yam, Ho-Kwan & Mercer, Stewart W. & Wong, Lai-Yi & Chan, Wan-Kin & Yeoh, Eng-Kiong, 2009. "Public and private healthcare services utilization by non-institutional elderly in Hong Kong: Is the inverse care law operating?," Health Policy, Elsevier, vol. 91(3), pages 229-238, August.
    2. Benjamin M Hunter & Sean Harrison & Anayda Portela & Debra Bick, 2017. "The effects of cash transfers and vouchers on the use and quality of maternity care services: A systematic review," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-37, March.
    3. Nachtnebel, Matthias & O'Mahony, Ashleigh & Pillai, Nandini & Hort, Kris, 2015. "Effectively engaging the private sector through vouchers and contracting – A case for analysing health governance and context," Social Science & Medicine, Elsevier, vol. 145(C), pages 193-200.
    4. Nguyen, Ha T.H. & Hatt, Laurel & Islam, Mursaleena & Sloan, Nancy L. & Chowdhury, Jamil & Schmidt, Jean-Olivier & Hossain, Atia & Wang, Hong, 2012. "Encouraging maternal health service utilization: An evaluation of the Bangladesh voucher program," Social Science & Medicine, Elsevier, vol. 74(7), pages 989-996.
    5. John Tayu Lee & Fozia Hamid & Sanghamitra Pati & Rifat Atun & Christopher Millett, 2015. "Impact of Noncommunicable Disease Multimorbidity on Healthcare Utilisation and Out-Of-Pocket Expenditures in Middle-Income Countries: Cross Sectional Analysis," PLOS ONE, Public Library of Science, vol. 10(7), pages 1-18, July.
    6. Schmidt, Jean-Olivier & Ensor, Tim & Hossain, Atia & Khan, Salam, 2010. "Vouchers as demand side financing instruments for health care: A review of the Bangladesh maternal voucher scheme," Health Policy, Elsevier, vol. 96(2), pages 98-107, July.
    7. Wong, Eliza L.Y. & Yeoh, Eng-kiong & Chau, Patsy Y.K. & Yam, Carrie H.K. & Cheung, Annie W.L. & Fung, Hong, 2015. "How shall we examine and learn about public-private partnerships (PPPs) in the health sector? Realist evaluation of PPPs in Hong Kong," Social Science & Medicine, Elsevier, vol. 147(C), pages 261-269.
    8. Claire Watt & Timothy Abuya & Charlotte E Warren & Francis Obare & Lucy Kanya & Ben Bellows, 2015. "Can Reproductive Health Voucher Programs Improve Quality of Postnatal Care? A Quasi-Experimental Evaluation of Kenya’s Safe Motherhood Voucher Scheme," PLOS ONE, Public Library of Science, vol. 10(4), pages 1-20, April.
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