The effect of exemption from co-payment on adolescent utilisation of primary health care. : The case of Norway

In Norway, children and adolescents under a specific age have been exempted from co-payment when they consume health care service provided by a GP. The age threshold for co-payment has been raised several times in the country. At the latest revision, the threshold was raised from 12 to 16 years of age effective July 1, 2010. Previous studies found that exemption from co-payment led to an increase in consumption of health care. However, there seems to be scarcity of studies investigating the effect of exemption from co-payment on the number of GP contacts by adolescents in the Scandinavian region. The socio-economic environment of the countries studied seems to be different from the Norwegian context. Aim: The aim of the study was to investigate if exemption from co-payment was significantly associated with an increase in the number of GP contacts among adolescents. Method: All adolescents born in 1998, 1996 and 1994 and who had at least one GP contact in one or more of three observation years constituted the study sample (N=357,724). A sample consisting of three birth cohorts allowed analysis of the effect of co-payment policy on adolescents of different ages. The data was obtained from the KUHR database of the Norwegian Directorate of Health. A Poisson regression model was fitted because the dependent variable was a count data and had non-normal distribution. GLM was used to fit a Poisson regression so that the dependent variable – GP contacts – is linearly related to the explanatory variables via a log-link function. The model was controlled for possible confounders including patient’s sex, age, birth cohort, proportion of contacts with male GP, and proportion of contacts with non-specialist GP. Results: Mean GP contacts of 9-17 year-old adolescents was 3.06 [95% CI (3.05 , 3.07)] per year. Adolescents exempted from co-payment had significantly more GP contacts when compared with their peers who were not eligible for exemption (p-value < 0.005). Marginal effect of exemption, ceteris paribus, was predicted and exemption from co-payment was associated with an increase of 0.26 GP contacts in a year. This means that adolescents not required to share the cost of health care, increased their number of GP contacts by 0.26 per year compared to their peers who paid the co-payment fee. Patient’s gender, age and birth cohort were also found to have significant association with the number of GP contacts. Conclusion: Exemption from co-payment is significantly associated with an increase in the number of GP contacts among adolescents. The findings uncover the importance of raising the age threshold further to exempt young people in their late adolescence as older adolescents are responsive to exemption from co-payment and have more health care needs compared to younger adolescents

Parental divorce in late adolescence does not seem to increase mental health problems: a population study from Norway

Background Former studies have shown increased mental health problems in adolescents after parental divorce all over the Western world. We wanted to see if that still is the case in Norway today when divorce turns to be more and more common. Methods In a prospective study design, two samples were constituted, adolescents at a baseline survey in 2001/02 (n = 2422) and those at follow-up in 2003/04 (n = 1861), when the adolescents were 15/16 and 18/19 years-old, respectively. They answered self-administered questionnaires in both surveys of Young-HUBRO in Oslo. Early parental divorce was defined as that which occured before age 15/16 years, and late divorce occured between age 15/16 and 18/19. Internalized and externalized mental health problems were measured by the Hopkin’s Symptom Check List (HSCL-10) and the Strengths and Difficulties Questionnaire (SDQ). Results After linear regression models were adjusted for gender, ethnicity, family economy, social support, and mental health problem symptoms measured at baseline before parental divorce occured, late parental divorce did not lead to significant increase in mental health problems among adolescents in the city of Oslo. Early parental divorce was associated with internal mental health problems among young adolescents when adjusted only for the first four possible confounders. Conclusions It seems that parental divorce in late adolescence does not lead to mental health problems in Norway any more, as has been shown before, while such problems may prevail among young adolescents. This does not mean that parental divorce create less problems in late adolescence than before but these youths might have developed adjustment abilities against health effects as divorce have turned to be more common