(P-413) Incentive Structure of Employer Health Insurance and Impact on Patient Drug Use and Cost of Accessing the Private Primary Healthcare System

Background: Uncontrolled drug pricing contributes to high drug expenditures, which is common in private health system that usually requires patients to have health insurance to cover the cost of access to the health system. However, little is known about how the incentive structure of health insurance in this setting influences the use of health system in terms of drug use and its costs.

Objectives: This study evaluated the structure of employer health insurance coverage and its impact on patient drug use and the cost of accessing the services in the primary private healthcare system

Methods: This retrospective study used the PMCare claims database assessing outpatient clinic visits by International Islamic University Malaysia (IIUM) community members to the private medical clinics of general practitioners (GPs) from January 2016 to August 2019. Extracted data included claim codes, drug costs, consultation fees, total costs, drug names and doses, duration of the prescription, and number of tablets prescribed. The IIUM insurance coverage limit is Ringgit Malaysia (RM) 45/outpatient visit (equivalent to USD 10.58). The monthly percentage change between January 2016 and August 2019 in the number of clinic visits, drug costs, GP consultation fees, total costs, and the number of drugs prescribed per patient per clinic visit were measured. Linear trend analysis was performed using Stata v15.1.

Results: A total of 83,556 outpatient clinic visits were made by 10,150 IIUM community members (48.85% female; mean age, 26.33 ± 17.63 years) during the study period. The number of clinic visits per patient was increased by 17% from January 2016 to August 2019. The increase was also recorded for consultation fees (an increase, 113.9%) and total cost (an increase, 7.9%) per clinic visit per patient. Conversely, drug costs and the number of drugs prescribed per clinic visit per patient was decreased by 39.7% and 6.3% respectively, during the same study period.

Conclusions: The decrease in drug costs and the number of drugs prescribed per clinic visit may be partly attributed to the incentive structure of employer health insurance, which limits patient access to prescription drugs. This finding showed an example of how incentives in health insurance system end up with creating perverse incentives, with negative consequences for the health system and health insurers.