Acknowledgements: Thank you to the study participants, PATH Interviewers, Karen Maxwell and Trish Jacomb; and to the other PATH Chief Investigators: Kaarin Anstey, Helen Christensen, Anthony Jorm, Bryan Rodgers, Andrew Mackinnon, Simon Easteal and Nicolas Cherbuin. The PATH Through Life Study is funded by National Health and Medical Research Council Grants 973302, 179805 and 418039. Peter Butterworth is funded by ARC Future Fellowship FT13101444.Peer reviewedPostprin

Butterworth, Peter

McNamee, Paul

Pymont, Carly

Health Policy

English

This paper examines the effect of out-of-pocket costs on subsequent frequent attendance in primary care using data from the Personality and Total Health (PATH) Through Life Project, a representative community cohort study from Canberra, Australia. The analysis sample comprised 1197 respondents with two or more GP consultations, and uses survey data linked to administrative health service use (Medicare) data which provides data on the number of consultations and out-of-pocket costs. Respondents identified in the highest decile of GP use in a year were defined as Frequent Attenders (FAs). Logistic regression models that did not account for potential selection effects showed that out-of-pocket costs incurred during respondents’ prior two consultations were significantly associated with subsequent FA status. Respondents who incurred higher costs ($15–$35; or &gt;$35) were less likely to become FAs than those who incurred no or low (&lt;AUS$15 per consultation) costs, with no difference evident between the no and low-cost groups. However, a counterfactual model that adjusted for factors associated with the selection into payment levels did not find an influence of payment, with only a non-significant gradient in the expected direction. Hence these findings raise doubts that price drives FA behaviour, suggesting that co-payments are unlikely to affect the number of GP consultations amongst frequent attenders.</p

University of Canberra Research Repository

Out-of-pocket costs, primary care frequent attendance and sample selection:Estimates from a longitudinal cohort design

This paper examines the effect of out-of-pocket costs on subsequent frequent attendance in primary care using data from the Personality and Total Health (PATH) Through Life Project, a representative community cohort study from Canberra, Australia. The analysis sample comprised 1197 respondents with two or more GP consultations, and uses survey data linked to administrative health service use (Medicare) data which provides data on the number of consultations and out-of-pocket costs. Respondents identified in the highest decile of GP use in a year were defined as Frequent Attenders (FAs). Logistic regression models that did not account for potential selection effects showed that out-of-pocket costs incurred during respondents' prior two consultations were significantly associated with subsequent FA status. Respondents who incurred higher costs ($15-$35; or >$35) were less likely to become FAs than those who incurred no or low (<AUS$15 per consultation) costs, with no difference evident between the no and low-cost groups. However, a counterfactual model that adjusted for factors associated with the selection into payment levels did not find an influence of payment, with only a non-significant gradient in the expected direction. Hence these findings raise doubts that price drives FA behaviour, suggesting that co-payments are unlikely to affect the number of GP consultations amongst frequent attenders.The PATH Through Life Study is funded by National Health and Med-ical Research Council Grants 973302, 179805 and 418039. PeterButterworth is funded by ARC Future Fellowship FT1310144

The Australian National University

Out-of-pocket costs, primary care frequent attendance and sample selection: Estimates from a longitudinal cohort design

Carly Pymont

Paul McNamee

Peter Butterworth

Crossref

Acknowledgements: Thank you to the study participants, PATH Interviewers, Karen Maxwell and Trish Jacomb; and to the other PATH Chief Investigators: Kaarin Anstey, Helen Christensen, Anthony Jorm, Bryan Rodgers, Andrew Mackinnon, Simon Easteal and Nicolas Cherbuin. The PATH Through Life Study is funded by National Health and Medical Research Council Grants 973302, 179805 and 418039. Peter Butterworth is funded by ARC Future Fellowship FT13101444.Peer reviewe

Aberdeen University Research

Out-of-pocket costs, primary care frequent attendance and sample selection : Estimates from a longitudinal cohort design

https://openresearch-repository.anu.edu.au/bitstream/1885/143596/1/1-s2.0-S016885101830068X-main.pdf

Out-of-pocket costs, primary care frequent attendance and sample selection : Estimates from a longitudinal cohort design

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Aberdeen University Research