Presentation (CTI)

OBJECTIVES: Regular primary care visits form a key aspect of good chronic care management as it facilitates early intervention and reduces the likelihood of related acute complications. To investigate whether financial incentives are effective in increasing primary care utilisation and subsequently reducing acute utilisation, we examined the causal effects of the Merdeka Generation Package (MGP), which was introduced by the Singapore government in 2019 to support seniors through additional subsidies for outpatient care.
METHODS: Using administrative health records for the primary and acute care settings, we conducted a quasi-experimental study by comparing seniors who were born just above and below the birth year of 1959 since eligibility for the MGP was strictly based on birth year (i.e., 1950 to 1959). Further heterogeneity analysis was conducted to examine the impact on healthcare expenditure based on the size of the subsidy increase received.
RESULTS: The provision of more primary care subsidies resulted in a 3% to 12% increase in primary care expenditure, on average. This was driven by increases in the number of visits, and the effect was higher amongst seniors who received larger subsidy increases. Furthermore, we found that the subsidies led to a substitution from public to private primary care providers. This suggested that the subsidies had improved affordability of private clinics and therefore, allowed greater flexibility in patients’ choice of providers, as private clinics generally provided greater convenience but at a higher cost. Meanwhile, there was no evidence that increased primary care utilisation reduced downstream acute utilisation in the three years following the MGP.
CONCLUSIONS: Financial subsidies can be an effective tool to increase primary care utilisation amongst seniors. However, as our study did not find evidence of its downstream impact on acute expenditure in the immediate years, future studies should delve into the longer-term effects on acute expenditure.