IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v281y2021ics0277953621004019.html
   My bibliography  Save this article

Failure to take-up public healthcare entitlements: Evidence from the Medical Card system in Ireland

Author

Listed:
  • Keane, Claire
  • Regan, Mark
  • Walsh, Brendan

Abstract

While population health and welfare can be improved through the provision of non-cash benefits, such as free healthcare, many welfare improving schemes have low rates of take up amongst those eligible for such a benefit. One interesting example of this is the Medical Card scheme in Ireland. Medical Cards are a non-cash benefit that provide free primary, community, and hospital care, as well as heavily subsidised prescriptions drugs, for those below specific income means-test threshold. However, despite the significant benefits afforded by a Medical Card, many people forego entitlement. While this has been of concern to policymakers, the prevalence of, and reason for, non-take up, have to date not been examined in-depth. Using detailed household demographic, healthcare, income and expenditure data, this paper estimates the Medical Card take-up rate, examines the reasons for non-take, and estimates the additional healthcare cost burden to individuals due to non-take-up. The paper estimates that 31% of eligible individuals do not take up a Medical Card. Private health insurance coverage, receipt of social welfare, employment status and health status are all strongly correlated with take up. Results suggest that of a lack of information about eligibility status and social stigma are key factors driving non take up. The paper estimates that families who forego their entitled Medical Card typically spend an additional €202 annually on healthcare. Furthermore, as a consequence of higher purchase rates of, perhaps unnecessary, private health insurance, families not taking up their entitlement spend an additional €489 per annum on PHI premia. Welfare losses are likely to be even higher if forgoing medical care due to cost results in future negative health outcomes.

Suggested Citation

  • Keane, Claire & Regan, Mark & Walsh, Brendan, 2021. "Failure to take-up public healthcare entitlements: Evidence from the Medical Card system in Ireland," Social Science & Medicine, Elsevier, vol. 281(C).
    • Handle: RePEc:eee:socmed:v:281:y:2021:i:c:s0277953621004019
    DOI: 10.1016/j.socscimed.2021.114069
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953621004019
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2021.114069?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Ku, Yu-Chun & Chou, Yiing-Jenq & Lee, Miaw-Chwen & Pu, Christy, 2019. "Effects of National Health Insurance on household out-of-pocket expenditure structure," Social Science & Medicine, Elsevier, vol. 222(C), pages 1-10.
    2. Janet Currie & Jonathan Gruber, 1996. "Health Insurance Eligibility, Utilization of Medical Care, and Child Health," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 111(2), pages 431-466.
    3. Sheelah Connolly & Anne Nolan & Brendan Walsh & Maev-Ann Wren, 2018. "Universal GP Care in Ireland: Potential Cost Implications," The Economic and Social Review, Economic and Social Studies, vol. 49(1), pages 93-109.
    4. Nolan, Anne, 2011. "An extension in eligibility for free primary care and avoidable hospitalisations: A natural experiment," Social Science & Medicine, Elsevier, vol. 73(7), pages 978-985.
    5. Dolores De La Mata, 2012. "The Effect Of Medicaid Eligibility On Coverage, Utilization, And Children'S Health," Health Economics, John Wiley & Sons, Ltd., vol. 21(9), pages 1061-1079, September.
    6. Arrighi, Yves & Davin, Bérengère & Trannoy, Alain & Ventelou, Bruno, 2015. "The non-take up of long-term care benefit in France: A pecuniary motive?," Health Policy, Elsevier, vol. 119(10), pages 1338-1348.
    7. Saurabh Bhargava & Dayanand Manoli, 2015. "Psychological Frictions and the Incomplete Take-Up of Social Benefits: Evidence from an IRS Field Experiment," American Economic Review, American Economic Association, vol. 105(11), pages 3489-3529, November.
    8. Wren, Maev-Ann & Keegan, Conor & Walsh, Brendan & Bergin, Adele & Eighan, James & Brick, Aoife & Connolly, Sheelah & Watson, Dorothy & Banks, Joanne, 2017. "Projections of demand for healthcare in Ireland, 2015-2030: First report from the Hippocrates Model," Research Series, Economic and Social Research Institute (ESRI), number RS67.
    9. Brendan Walsh & Mary Silles & Ciaran O'Neill, 2012. "The Role Of Private Medical Insurance In Socio‐Economic Inequalities In Cancer Screening Uptake In Ireland," Health Economics, John Wiley & Sons, Ltd., vol. 21(10), pages 1250-1256, October.
    10. Kanika Kapur, 2020. "Private Health Insurance in Ireland: Trends and Determinants," The Economic and Social Review, Economic and Social Studies, vol. 51(1), pages 63-92.
    11. Watson, Dorothy & Maître, Bertrand & Grotti, Raffaele & Whelan, Christopher T., 2018. "Poverty Dynamics of Social Risk Groups in the EU: an analysis of the EU Statistics on Income and Living Conditions, 2005 to 2014," Research Series, Economic and Social Research Institute (ESRI), number BKMNEXT345.
    12. Walsh, Brendan & Nolan, Anne & Brick, Aoife & Keegan, Conor, 2019. "Did the expansion of free GP care impact demand for Emergency Department attendances?," Papers RB201901, Economic and Social Research Institute (ESRI).
    13. Keegan, Conor, 2020. "The introduction of lifetime community rating in the Irish private health insurance market: Effects on coverage and plan choice," Social Science & Medicine, Elsevier, vol. 255(C).
    14. Johnston, Bridget M. & Burke, Sara & Barry, Sarah & Normand, Charles & Ní Fhallúin, Maebh & Thomas, Steve, 2019. "Private health expenditure in Ireland: Assessing the affordability of private financing of health care," Health Policy, Elsevier, vol. 123(10), pages 963-969.
    15. Keegan, Conor, 2020. "The introduction of lifetime community rating in the Irish private health insurance market: Effects on coverage and plan choice (Title TBC)," Papers RB202007, Economic and Social Research Institute (ESRI).
    16. Walsh, Brendan & Nolan, Anne & Brick, Aoife & Keegan, Conor, 2019. "Did the expansion of free GP care impact demand for Emergency Department attendances? A difference-in-differences analysis," Social Science & Medicine, Elsevier, vol. 222(C), pages 101-111.
    17. Remler, D.K. & Glied, S.A., 2003. "What other programs can teach us: Increasing participation in health insurance programs," American Journal of Public Health, American Public Health Association, vol. 93(1), pages 67-74.
    18. Erus, Burcay & Yakut-Cakar, Burcu & Cali, Sanda & Adaman, Fikret, 2015. "Health policy for the poor: An exploration on the take-up of means-tested health benefits in Turkey," Social Science & Medicine, Elsevier, vol. 130(C), pages 99-106.
    19. Wren, Maev-Ann & Connolly, Sheelah, 2019. "A European late starter: lessons from the history of reform in Irish health care," Health Economics, Policy and Law, Cambridge University Press, vol. 14(3), pages 355-373, July.
    20. Whyte, Richard & Connolly, Sheelah, 2019. "Uptake of cancer screening services among middle and older ages in Ireland: the role of healthcare eligibility (title may change)," Papers RB201914, Economic and Social Research Institute (ESRI).
    21. Stuber, Jennifer & Schlesinger, Mark, 2006. "Sources of stigma for means-tested government programs," Social Science & Medicine, Elsevier, vol. 63(4), pages 933-945, August.
    22. Colm Harmon & Brian Nolan, 2001. "Health insurance and health services utilization in Ireland," Health Economics, John Wiley & Sons, Ltd., vol. 10(2), pages 135-145, March.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Claire Keane & Karina Doorley & Theano Kakoulidou & Seamus O’Malley, 2023. "SWITCH: A Tax-Benefit Model for Ireland Linked to Survey and Register Data," International Journal of Microsimulation, International Microsimulation Association, vol. 16(1), pages 65-88.
    2. Connolly, Sheelah & Brick, Aoife & O'Neill, Ciarán & O'Callaghan, Michael, 2022. "An analysis of the primary care systems of Ireland and Northern Ireland," Research Series, Economic and Social Research Institute (ESRI), number RS137.
    3. Keane, Claire & Doolan, Claire, 2023. "Cliff edges in the Irish Tax-Benefit system," Papers BP2024/1, Economic and Social Research Institute (ESRI).
    4. Walsh, Brendan & Mac Domhnaill, Ciarán & Mohan, Gretta, 2021. "Developments in healthcare information systems in Ireland and internationally," Research Series, Economic and Social Research Institute (ESRI), number SUSTAT105.
    5. Diego Muñoz-Higueras & Stephan Köppe & Rafael Granell & Amadeo Fuenmayor, 2024. "Non-take-up of in-work benefits: determinants, benefit erosion and indexing," Journal for Labour Market Research, Springer;Institute for Employment Research/ Institut für Arbeitsmarkt- und Berufsforschung (IAB), vol. 58(1), pages 1-19, December.
    6. Walsh, Brendan & Keegan, Conor & Brick, Aoife & Connolly, Sheelah & Bergin, Adele & Wren, Maev-Ann & Lyons, Seán & Hill, Leonie & Smith, Samantha, 2021. "Projections of expenditure for primary, community and long-term care Ireland, 2019–2035, based on the Hippocrates model," Research Series, Economic and Social Research Institute (ESRI), number RS126.
    7. Keane, Claire & Seán Lyons & Mark Regan & Walsh, Brendan, 2022. "Home support services in Ireland: Exchequer and distributional impacts of funding options," Research Series, Economic and Social Research Institute (ESRI), number SUSTAT111.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Walsh, Brendan & Keegan, Conor & Brick, Aoife & Connolly, Sheelah & Bergin, Adele & Wren, Maev-Ann & Lyons, Seán & Hill, Leonie & Smith, Samantha, 2021. "Projections of expenditure for primary, community and long-term care Ireland, 2019–2035, based on the Hippocrates model," Research Series, Economic and Social Research Institute (ESRI), number RS126.
    2. Walsh, Brendan & Wren, Maev-Ann & Smith, Samantha & Lyons, Seán & Eighan, James & Morgenroth, Edgar, 2019. "An analysis of the effects on Irish hospital care of the supply of care inside and outside the hospital," Research Series, Economic and Social Research Institute (ESRI), number RS91.
    3. Keegan, Conor & Brick, Aoife & García-Rodríguez, Abián & Hill, Leonie, 2022. "Projections of workforce requirements for public acute hospitals in Ireland, 2019–2035: a regional analysis based on the hippocrates model," Research Series, Economic and Social Research Institute (ESRI), number RS147.
    4. Brendan Walsh & Seán Lyons & Samantha Smith & Maev‐Ann Wren & James Eighan & Edgar Morgenroth, 2020. "Does formal home care reduce inpatient length of stay?," Health Economics, John Wiley & Sons, Ltd., vol. 29(12), pages 1620-1636, December.
    5. Walsh, Brendan & Nolan, Anne & Brick, Aoife & Keegan, Conor, 2019. "Did the expansion of free GP care impact demand for Emergency Department attendances? A difference-in-differences analysis," Social Science & Medicine, Elsevier, vol. 222(C), pages 101-111.
    6. McDonnell, Thérèse & Nicholson, Emma & Bury, Gerard & Collins, Claire & Conlon, Ciara & Denny, Kevin & O'Callaghan, Michael & McAuliffe, Eilish, 2022. "Policy of free GP care for children under 6 years: The impact on daytime and out-of-hours general practice," Social Science & Medicine, Elsevier, vol. 296(C).
    7. Connolly, Sheelah & Wren, Maev-Ann, 2023. "Towards universal healthcare in Ireland – what can we learn from the literature?," Research Series, Economic and Social Research Institute (ESRI), number SUSTAT121.
    8. Walsh, Brendan & Mac Domhnaill, Ciarán & Mohan, Gretta, 2021. "Developments in healthcare information systems in Ireland and internationally," Research Series, Economic and Social Research Institute (ESRI), number SUSTAT105.
    9. Connolly, Sheelah & Brick, Aoife & O'Neill, Ciarán & O'Callaghan, Michael, 2022. "An analysis of the primary care systems of Ireland and Northern Ireland," Research Series, Economic and Social Research Institute (ESRI), number RS137.
    10. Friedrichsen, Jana & König, Tobias & Schmacker, Renke, 2018. "Social image concerns and welfare take-up," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 168, pages 174-192.
    11. Melissa McInerney & Jennifer M. Mellor & Lindsay M. Sabik, 2021. "Welcome Mats and On‐Ramps for Older Adults: The Impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 40(1), pages 12-41, January.
    12. Laura R. Wherry & Bruce D. Meyer, 2016. "Saving Teens: Using a Policy Discontinuity to Estimate the Effects of Medicaid Eligibility," Journal of Human Resources, University of Wisconsin Press, vol. 51(3), pages 556-588.
    13. Delis, Manthos & Galariotis, Emilios & Monne, Jerome, 2021. "Financial vulnerability and seeking expert advice: Evidence from a survey experiment," MPRA Paper 107095, University Library of Munich, Germany.
    14. Aimee Chabot & Maximilian Hell, 2023. "Using Technology and Iterative Research to Strengthen the Social Safety Net," The ANNALS of the American Academy of Political and Social Science, , vol. 706(1), pages 256-275, March.
    15. Mingming Xu & Benjamin Bittschi, 2022. "Does the abolition of copayment increase ambulatory care utilization?: a quasi-experimental study in Germany," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(8), pages 1319-1328, November.
    16. Mohan, Gretta & Nolan, Anne & Lyons, Seán, 2019. "An investigation of the effect of accessibility to General Practitioner services on healthcare utilisation among older people," Social Science & Medicine, Elsevier, vol. 220(C), pages 254-263.
    17. Conor Keegan & Aoife Brick & Brendan Walsh & Adele Bergin & James Eighan & Maev‐Ann Wren, 2019. "How many beds? Capacity implications of hospital care demand projections in the Irish hospital system, 2015‐2030," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(1), pages 569-582, January.
    18. Keegan, Conor & Brick, Aoife & Bergin, Adele & Wren, Maev-Ann & Whyte, Richard & Henry, Edward, 2020. "Projections of expenditure for public hospitals in Ireland, 2018–2035, based on the Hippocrates Model," Research Series, Economic and Social Research Institute (ESRI), number RS117.
    19. Brendan Walsh & Samantha Smith & Maev-Ann Wren & James Eighan & Seán Lyons, 2022. "The impact of inpatient bed capacity on length of stay," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(3), pages 499-510, April.
    20. Andrey Aistov & Ekaterina Aleksandrova & Christopher J. Gerry, 2021. "Voluntary private health insurance, health-related behaviours and health outcomes: evidence from Russia," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(2), pages 281-309, March.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:281:y:2021:i:c:s0277953621004019. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.