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Barrier to Access or Cost Share? Coinsurance and Dental-Care Utilization in Colombia

Author

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  • Lucas Higuera

    (University of Minnesota)

  • Sergio Iván Prada

    (Universidad ICESI & PROESA)

Abstract

Background Copayments, deductibles, and coinsurance, are elements of health-care systems to make prices salient for the insured. Individuals may respond differently to cost sharing, according to the type of care they seek; dental care, as a combination of both acute and elective care, is an ideal setting to study the effects of cost-sharing mechanisms on utilization. Objective To test how coinsurance affects dental-care utilization in a middle-income country context. Methods This study uses policy variations in the Colombian health-care system to analyze changes in dental-care utilization due to different levels of coinsurance. We used matching procedures to balance observed differences in pre-treatment variables between those who face coinsurance (non-policy holders, or beneficiaries) and those who don’t (policyholders). We use zero-inflated negative binomial models for the count of visits and two-part models for total expenditures, and test for unobservable confounders with random-effect models and instrumental variables. Results Individuals who face coinsurance are less likely to have any dental-care utilization, at a relatively small scale. Facing coinsurance does not correlate with changes in total expenditures. Falsification tests with dental-care visits exempt from coinsurance show no statistically distinguishable changes in utilization. Random-effect models and instrumental variable models show results similar to the main specification. Conclusions Cost-sharing policies in Colombia seem to be well designed because they don’t represent an important barrier to dental-care access.

Suggested Citation

  • Lucas Higuera & Sergio Iván Prada, 2016. "Barrier to Access or Cost Share? Coinsurance and Dental-Care Utilization in Colombia," Applied Health Economics and Health Policy, Springer, vol. 14(5), pages 569-578, October.
    • Handle: RePEc:spr:aphecp:v:14:y:2016:i:5:d:10.1007_s40258-016-0251-4
    DOI: 10.1007/s40258-016-0251-4
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    References listed on IDEAS

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    1. Cameron,A. Colin & Trivedi,Pravin K., 2013. "Regression Analysis of Count Data," Cambridge Books, Cambridge University Press, number 9781107667273.
    2. Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-277, June.
    3. Hitoshi Shigeoka, 2014. "The Effect of Patient Cost Sharing on Utilization, Health, and Risk Protection," American Economic Review, American Economic Association, vol. 104(7), pages 2152-2184, July.
    4. Duarte, Fabian, 2012. "Price elasticity of expenditure across health care services," Journal of Health Economics, Elsevier, vol. 31(6), pages 824-841.
    5. Kim, Jiyun & Ko, Sukyoung & Yang, Bongmin, 2005. "The effects of patient cost sharing on ambulatory utilization in South Korea," Health Policy, Elsevier, vol. 72(3), pages 293-300, June.
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