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Co-payments help determine how expensive an individual health service is both to payers and to enrollees. The Japanese government had provided its elderly with first dollar coverage, including pharmac...euticals, until January 2001 when it introduced 10% co-payments in an effort to contain costs. We evaluated whether the Japanese increase in co-payments reduced compliance with necessary care, including prescription pharmaceuticals, in elderly patients with chronic illness. Subjects were members of the Health Care System for the Aged (persons age 70 or older) who belonged to a health insurance society located in Fukuoka Prefecture continuously from January 2000 to December 2001. We defined 234 highly compliant patients with hypertension and 35 with diabetes mellitus who visited physicians at least once per month during every month of the 6-month period from January to June 2000. We used time series analyses to compare medical service use during 6 months before and 12 months after the 10% co-payments were introduced. During this study, medical visits were necessary to obtain prescriptions for pharmaceuticals in Japan. Compliance decreased significantly for both hypertension and diabetes mellitus patients after the introduction of 10% co-payments, controlling for the possible impact of secular trends. The impact on necessary pharmaceutical use was likewise affected. However, the impact on costs was not as marked. Co-payments have a major impact on patient compliance and recommended medical service use (but perhaps not on costs), especially in the elderly with chronic diseases.show more
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