Efeito de coparticipação no número de consultas médicas eletivas em modelos dinâmicos de contagem

Abstract

One of the main difficulties faced by health insurance companies is the overuse of the services by consumers, which tends to cause the dissatisfaction of users in what relates to the fulfillment of their demands. Therefore, the search for strategies that provide a higher level of efficiency in the use of medical care is one of the most important concerns of companies of this sector. Thus, given the importance of this market and the difficulties faced by it, this paper aims to analyze the distribution of the number of medical appointments (CME), taking into account the characteristics of the individuals, the types of health insurance plans and other factors that determines the demand for medical care. Specifically, the intention is to identify the effect of copayment on the number of medical appointments (CME) scheduled by the users of a private health insurance plan, through the use of a longitudinal dynamic count model with initial conditions. The inclusion of the state of dependence in the count model and the number of medical appointments in the first year of the research intend to control idiosyncrasies and therefore to identify the effect of copayment in a manner more accurate than that which one may verify in static models. The data encompass a longitudinal base of 82,557 individuals followed throughout the period of four years. The main conclusion about the rate of coinsurance of 20% is that it causes, on the average, a reduction of 7.15% in the number of medical appointments per individual/year.