Patient copayments in primary medical care

Penfold, Christopher Michael 2011. Patient copayments in primary medical care. PhD Thesis, Cardiff University.

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Abstract

This research was carried out to assess the feasibility of studying the effects of introducing copayments in primary medical care via studying the effects of copayments in primary dental care. Quantitative methods were used to investigate the impact of primary dental care copayments on patients and to compare predictors of primary medical and dental care uptake. Qualitative methods were used to investigate attitudes towards copayments for NHS primary health services and their extension to include primary medical consultations. Regression models, chi-square analyses and ANOVA were applied to the England and Wales sub-sample of nationally representative self-report data from the 1998 Adult Dental Health Survey (ADHS) (n=3628) to investigate the impact of copayments on primary dental care uptake. Regression models and chi-square analyses were applied to the England and Wales sub-sample of nationally representative self-report data from the 1997/98 British Household Panel Survey (BHPS) (n=8526) and the 1998 ADHS (n=3641) to compare predictors of primary medical and dental consultations. Semi- structured interviews were undertaken in Bristol and Somerset with purposively sampled frequent and infrequent primary medical care users (n=19). Predictors of primary medical and dental care utilisation differed across predisposing, enabling and illness level factors. Private and NHS dental copayments were perceived to be expensive and this perception was associated with lower preventive-led dental consultation rates, but not with treatment-led consultation rates. Copayments for services affected the nature of the patient-practitioner relationship. Findings were inconclusive regarding the effect of copayment exemption status on people's decisions to consult a dentist and on dental treatments received. It was not feasible to study the effects of introducing copayments in primary medical care via studying the effects of copayments in primary dental care.

Item Type:	Thesis (PhD)
Status:	Unpublished
Schools:	Dentistry
Subjects:	R Medicine > RA Public aspects of medicine
ISBN:	9781303196003
Funders:	Brickley Research Foundation
Date of First Compliant Deposit:	30 March 2016
Last Modified:	19 Mar 2016 23:29
URI:	https://orca.cardiff.ac.uk/id/eprint/54411

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