Table 2.

List of themes of physicians’ perceptions about possible legislation for lowering out-of-pocket payments by low-income patients

Category	Themes	Quotes
Agree/necessary	Equal access to health care	“High out-of-pocket payments prevent patients from seeking necessary medical care, which leads to poorer health.” “If they are asymptomatic, low-income patients soon stop taking medications. Those patients definitely need health education.”
	Better health necessary for better work status	“Receiving appropriate health care will enable patients to get a better job, which will lead to a better life.”
	Reducing future health-care costs	“Poorer health will lead to more ER visits and hospitalization, which will eventually result in increased overall health-care costs.”
Disagree/not necessary	Sharing equal burden in receiving care	“To avoid inequality and misuse of health-care benefits, the rate charged should be the same for everyone.”
	Responsibility in taking care of one’s own health condition and improving lifestyle	“If patients pay less for medical care, they will be less motivated to improve their lifestyles.” “Patients should spend more on medical care and quit spending on cigarettes and alcohol.”
	No need or merit	“The existing redemption systems are sufficient to protect the poor. Utilizing those systems should be enough.” “Other measures could be used to mitigate the burden for low-income patients.”
Challenges and potential measures for implementing the legislation	Tight government resources for health-care expenditure	“Any additional increase in health-care expenditure will make the government unable to maintain universal health coverage.” “Some measures need to be undertaken about the issues of high, rising drug costs.”
	Limiting the redemption for specific diseases and expensive treatment	“Expensive treatment, including diabetes medication such as insulin and some anti-cancer drugs, should be affordable to all patients who need it.”
	Potential risk of overutilization	“Free or low out-of-pocket payments might cause overutilization of medication. That is seen in patients on social welfare, who can get medicines for free, and should be avoided.”
Necessity to change the current policy of patients on social welfare paying no charges	Wide gaps in the payment burden between those on social welfare and those not	“Even if their income is at the same level, people on social welfare can receive care for free, but others are charged the 30% co-payment. This gap is too big. Patients on social welfare should pay something for receiving care.”
	Moral hazard in health-care utilization among patients on social welfare	“Free care is problematic. Patients take it for granted.” “Patients come to see doctors too often and demand unnecessary tests and medications.”