Table 2 List of themes of physicians’ perceptions about possible legislation for lowering out-of-pocket payments by low-income patients
Category | Themes | Quotes |
|---|---|---|
Agree/necessary | Equal access to health care | “High out-of-pocket payments prevent patients from seeking necessary medical care, which leads to poorer health.” “If they are asymptomatic, low-income patients soon stop taking medications. Those patients definitely need health education.” |
Better health necessary for better work status | “Receiving appropriate health care will enable patients to get a better job, which will lead to a better life.” | |
Reducing future health-care costs | “Poorer health will lead to more ER visits and hospitalization, which will eventually result in increased overall health-care costs.” | |
Disagree/not necessary | Sharing equal burden in receiving care | “To avoid inequality and misuse of health-care benefits, the rate charged should be the same for everyone.” |
Responsibility in taking care of one’s own health condition and improving lifestyle | “If patients pay less for medical care, they will be less motivated to improve their lifestyles.” “Patients should spend more on medical care and quit spending on cigarettes and alcohol.” | |
No need or merit | “The existing redemption systems are sufficient to protect the poor. Utilizing those systems should be enough.” “Other measures could be used to mitigate the burden for low-income patients.” | |
Challenges and potential measures for implementing the legislation | Tight government resources for health-care expenditure | “Any additional increase in health-care expenditure will make the government unable to maintain universal health coverage.” “Some measures need to be undertaken about the issues of high, rising drug costs.” |
Limiting the redemption for specific diseases and expensive treatment | “Expensive treatment, including diabetes medication such as insulin and some anti-cancer drugs, should be affordable to all patients who need it.” | |
Potential risk of overutilization | “Free or low out-of-pocket payments might cause overutilization of medication. That is seen in patients on social welfare, who can get medicines for free, and should be avoided.” | |
Necessity to change the current policy of patients on social welfare paying no charges | Wide gaps in the payment burden between those on social welfare and those not | “Even if their income is at the same level, people on social welfare can receive care for free, but others are charged the 30% co-payment. This gap is too big. Patients on social welfare should pay something for receiving care.” |
Moral hazard in health-care utilization among patients on social welfare | “Free care is problematic. Patients take it for granted.” “Patients come to see doctors too often and demand unnecessary tests and medications.” |