Long-term effectiveness of elderly health care voucher scheme strategies: a system dynamics simulation analysis

Abstract

Background: The elderly healthcare voucher (EHCV) scheme is expected to lead to an increase in the number of elderly people selecting private primary healthcare services and reduce reliance on the public sector in Hong Kong. However, studies thus far have reported that this scheme has not received satisfactory responses. In this study, we examined changes in the ratio of visits between public and private doctors in primary care (to measure reliance on the public sector) for different strategic scenarios in the EHCV scheme.

Methods: Based on comments from an expert panel, a system dynamics model was formulated to simulate the impact of various enhanced strategies in the scheme: increasing voucher amounts, lowering the age eligibility, and designating vouchers for chronic conditions follow-up. Data and statistics for the model calibration were collected from various sources.

Results: The simulation results show that the current EHCV scheme is unable to reduce the utilization of public healthcare services, as well as the ratio of visits between public and private primary care among the local aging population. When comparing three different tested scenarios, even if the increase in the annual voucher amount could be maintained at the current pace or the age eligibility can be lowered to include those aged 60 years, the impact on shifts from public-to-private utilization were insignificant. The public-to-private ratio could only be marginally reduced from 0.74 to 0.64 in the first several years. Nevertheless, introducing a chronic disease-oriented voucher could result in a significant drop of 0.50 in the public-to-private ratio during the early implementation phase. However, the effect could not be maintained for an extended period.

Conclusions: Our findings will assist officials in improving the design of the EHCV scheme, within the wider context of promoting primary care among the elderly. We suggest that an additional chronic disease-oriented voucher can serve as an alternative strategy. The scheme must be redesigned to address more specific objectives or provide a separate voucher that promotes under-utilized healthcare services (e.g., preventive care), instead of services designed for unspecified reasons, which may lead to concerns regarding exploitation.

Keywords: Chronic; Elderly care; Elderly healthcare voucher; Financial incentive; Simulation; System dynamics.

Fig. 1

Diagram of the system dynamics model for generation of visits to healthcare services in a population

Fig. 2

Diagram of the system dynamics model for generation of visits using EHCV

Fig. 3

Diagram of the system dynamics model for generation of visits using vouchers for chronic diseases

Fig. 4

Diagram of the system dynamics model for generation of the actual number of visits using vouchers

Fig. 5

Diagram of the system dynamics model for changes in utilization of public healthcare services

Fig. 6

a Model-simulated expenditure and actual expenditure of voucher uses, b percentage of total visits by age group in the baseline scenario, and c comparison of total visits between public and private in the baseline scenario

Fig. 7

Changes in a public healthcare utilizations and b ratio of visits between public and private by years in different scenarios