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Cost-sharing design matters: A comparison of the rebate and deductible in healthcare

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  • Remmerswaal, Minke
  • Boone, Jan
  • Bijlsma, Michiel
  • Douven, Rudy

Abstract

Since 2006, the Dutch population has faced two different cost-sharing schemes in health insurance for curative care: a mandatory rebate in 2006 and 2007, and a mandatory deductible since 2008. With administrative data for the entire Dutch population and using a difference-in-differences design, we compare the effect of these schemes on healthcare consumption. We draw upon a regression discontinuity design to extrapolate effects to the cut-off age 18 and incorporate the size of the cost-sharing scheme. Our estimate shows that for individuals around the age of eighteen, one euro of the deductible reduces healthcare expenditures 18 eurocents more than one euro of the rebate. This demonstrates that different designs of a cost-sharing scheme can have substantially different effects on total healthcare expenditure.

Suggested Citation

  • Remmerswaal, Minke & Boone, Jan & Bijlsma, Michiel & Douven, Rudy, 2019. "Cost-sharing design matters: A comparison of the rebate and deductible in healthcare," Journal of Public Economics, Elsevier, vol. 170(C), pages 83-97.
    • Handle: RePEc:eee:pubeco:v:170:y:2019:i:c:p:83-97
    DOI: 10.1016/j.jpubeco.2019.01.008
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    1. Hayen, Arthur P. & Klein, Tobias J. & Salm, Martin, 2021. "Does the framing of patient cost-sharing incentives matter? the effects of deductibles vs. no-claim refunds," Journal of Health Economics, Elsevier, vol. 80(C).
    2. Johansson, Naimi & de New, Sonja C. & Kunz, Johannes S. & Petrie, Dennis & Svensson, Mikael, 2023. "Reductions in out-of-pocket prices and forward-looking moral hazard in health care demand," Journal of Health Economics, Elsevier, vol. 87(C).
    3. Minke Remmerswaal & Jan Boone & Rudy Douven, 2019. "Selection and moral hazard effects in healthcare," CPB Discussion Paper 393.rdf, CPB Netherlands Bureau for Economic Policy Analysis.
    4. Lopes, Francisca Vargas & Riumallo Herl, Carlos J. & Mackenbach, Johan P. & Van Ourti, Tom, 2022. "Patient cost-sharing, mental health care and inequalities: A population-based natural experiment at the transition to adulthood," Social Science & Medicine, Elsevier, vol. 296(C).
    5. Remmerswaal, Minke & Boone, Jan & Douven, Rudy, 2023. "Minimum generosity levels in a competitive health insurance market," Journal of Health Economics, Elsevier, vol. 90(C).
    6. Non, Mariëlle & van Kleef, Richard & van der Galiën, Onno & Douven, Rudy, 2019. "The effect of reinsuring a deductible on pharmaceutical spending: A Dutch case study on low-income people," Health Policy, Elsevier, vol. 123(10), pages 976-981.
    7. Avdic, Daniel & Decker, Simon & Karlsson, Martin & Salm, Martin, 2024. "No-claim refunds and healthcare use," Journal of Public Economics, Elsevier, vol. 230(C).
    8. Minke Remmerswaal & Jan Boone, 2020. "A Structural Microsimulation Model for Demand-Side Cost-Sharing in Healthcare," CPB Discussion Paper 415.rdf, CPB Netherlands Bureau for Economic Policy Analysis.
    9. Minke Remmerswaal & Jan Boone, 2020. "A Structural Microsimulation Model for Demand-Side Cost-Sharing in Healthcare," CPB Discussion Paper 415, CPB Netherlands Bureau for Economic Policy Analysis.
    10. Minke Remmerswaal & Jan Boone & Rudy Douven, 2019. "Selection and moral hazard effects in healthcare," CPB Discussion Paper 393, CPB Netherlands Bureau for Economic Policy Analysis.
    11. Oh, Byeung-Kuk, 2024. "Retirement and healthcare utilization: Evidence from pension eligibility ages in South Korea," The Journal of the Economics of Ageing, Elsevier, vol. 27(C).
    12. Feng, Tong & Sun, Yuechi & Shi, Yating & Ma, Jie & Feng, Chunmei & Chen, Zhenni, 2024. "Air pollution control policies and impacts: A review," Renewable and Sustainable Energy Reviews, Elsevier, vol. 191(C).

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