Objective To describe and analyze both the direct impact of emergency service (ES) cost sharing and the indirect impact of drug cost sharing on emergency service utilization (ESU) in health insurance plans. Methods The author searched18 electronic databases which were in the evidence-based, public health, economic and social categories, respectively, 2 grey literature review resources and Google search engine, and the retrieval time was from June 21st, 2011 to September 19th, 2011. According to the inclusion criteria, data screening and extraction were conducted by two reviewers independently, and the differences were discussed by a third person or a review group. The theme analysis was adopted to systematically analyze both the direct and indirect impacts of cost sharing on ESU. Additionally, the side effects were analyzed too. Results Among total 22 studies included, 13 described the direct impact of ESU cost sharing, while the other 9 referred to the indirect impact of drug cost sharing. There were mainly 5 categories of health plans involved in. The results showed that, ESU could respond to the cost sharing: ESU decreased when the proportion of copayment increased, and vice versa. The increase of drug copayment impaired the use of essential drugs and finally increased ESU. However, a modest ES copayment decreased the irrational ESU rather than the rational ESU. Conclusion To the insured, the increase of ES cost sharing would not decrease the rational ESU and has no adverse events, while the increase of drug cost sharing would lead to some adverse events such as the increase of ESU. To the uninsured, the impact of cost sharing needs to be further disccussed. So this review suggests, the proper ES self-payment should be introduced into the health insurance plans according to local economic status, resident income, etc.; in addition, the drug self-payment ratio should be determined cautiously.
Objective To systematically review the effects of cost sharing in health insurance schemes, so as to provide evidence for better designing cost sharing ratio in health insurance scheme. Methods The search terms were discussed, tested and then chosen by subject matter experts and search coordinators. The total 20 databases including comprehensive scope, health, economics, sociology, and grey literatures were searched to retrieve all the description or evaluation studies on the effects of cost sharing, such as health services utilization, financial burden or moral hazard. The information from the included studies was extracted into a pre-designed data extraction form, and then it was analyzed and summarized. Results A total of 73 studies were included, covering 17 countries like Australia, Canada, and China, etc. The results of statistical analyses showed that, a) Cost sharing methods were applied to every kind of health insurance scheme. The target population included general population, the elder, the poor, those with chronic disease and children, etc. The services covered clinic, hospitalization, mental health, prevention and drug; and b) The effects brought from cost sharing included: From full fee to cost sharing scheme, the enrollee in developing countries increased their health care utilization, and decreased their financial burden. From full coverage to cost sharing, the utilization of health services decreased in developed countries, but the cost of health insurance could not be reduced, and some undesirable effects were brought due to the decrease of both essential health service utilization and essential drugs compliance.