IDEAS home Printed from https://ideas.repec.org/a/spr/aphecp/v14y2016i5d10.1007_s40258-016-0251-4.html
   My bibliography  Save this article

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

Author

Listed:
  • 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
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s40258-016-0251-4
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.
    File URL: https://libkey.io/10.1007/s40258-016-0251-4?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. Cameron,A. Colin & Trivedi,Pravin K., 2013. "Regression Analysis of Count Data," Cambridge Books, Cambridge University Press, number 9781107014169.
    2. 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.
    3. 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.
    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.
    6. Cameron,A. Colin & Trivedi,Pravin K., 2013. "Regression Analysis of Count Data," Cambridge Books, Cambridge University Press, number 9781107667273.
    Full references (including those not matched with items on IDEAS)

    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. SeungHoon Han & Hosung Sohn, 2023. "The short-term effects of fixed copayment policy on elderly health spending and service utilization: evidence from South Korea’s age-based policy using exact date of birth," International Journal of Health Economics and Management, Springer, vol. 23(2), pages 255-279, June.
    2. Galina Besstremyannaya, 2014. "Heterogeneous effect of coinsurance rate on healthcare costs: generalized finite mixtures and matching estimators," Discussion Papers 14-014, Stanford Institute for Economic Policy Research.
    3. Kurt Lavetti & Thomas DeLeire & Nicolas R. Ziebarth, 2023. "How do low‐income enrollees in the Affordable Care Act marketplaces respond to cost‐sharing?," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 90(1), pages 155-183, March.
    4. Kim, Hyuncheol Bryant & Lee, Sun-mi, 2017. "When public health intervention is not successful: Cost sharing, crowd-out, and selection in Korea's National Cancer Screening Program," Journal of Health Economics, Elsevier, vol. 53(C), pages 100-116.
    5. Chung Jen Yang & Ying Che Tsai & Joseph J. Tien, 2017. "The Impacts of Persistent Behaviour and Cost-Sharing Policy on Demand for Outpatient Visits by the Elderly: Evidence from Taiwan’s National Health Insurance," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 42(1), pages 31-52, January.
    6. Eunja Park & Sookja Choi, 2020. "Who Benefits from the Fixed Copayment of Medical and Pharmaceutical Expenditure among the Korean Elderly?," IJERPH, MDPI, vol. 17(21), pages 1-11, November.
    7. 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.
    8. Nilsson, Anton & Paul, Alexander, 2018. "Patient cost-sharing, socioeconomic status, and children's health care utilization," Journal of Health Economics, Elsevier, vol. 59(C), pages 109-124.
    9. Giampiero Marra & Rosalba Radice & David Zimmer, 2021. "Did the ACA's “guaranteed issue” provision cause adverse selection into nongroup insurance? Analysis using a copula‐based hurdle model," Health Economics, John Wiley & Sons, Ltd., vol. 30(9), pages 2246-2263, September.
    10. Giampiero Marra & Rosalba Radice & David M. Zimmer, 2020. "Estimating the binary endogenous effect of insurance on doctor visits by copula‐based regression additive models," Journal of the Royal Statistical Society Series C, Royal Statistical Society, vol. 69(4), pages 953-971, August.
    11. Luiz Paulo Fávero & Joseph F. Hair & Rafael de Freitas Souza & Matheus Albergaria & Talles V. Brugni, 2021. "Zero-Inflated Generalized Linear Mixed Models: A Better Way to Understand Data Relationships," Mathematics, MDPI, vol. 9(10), pages 1-28, May.
    12. Tal Gross & Timothy J. Layton & Daniel Prinz, 2022. "The Liquidity Sensitivity of Healthcare Consumption: Evidence from Social Security Payments," American Economic Review: Insights, American Economic Association, vol. 4(2), pages 175-190, June.
    13. Riccardo (Jack) Lucchetti & Luca Pedini, 2020. "ParMA: Parallelised Bayesian Model Averaging for Generalised Linear Models," Working Papers 2020:28, Department of Economics, University of Venice "Ca' Foscari".
    14. Landry, Craig E. & Shonkwiler, J. Scott & Whitehead, John C., 2020. "Economic Values of Coastal Erosion Management: Joint Estimation of Use and Existence Values with recreation demand and contingent valuation data," Journal of Environmental Economics and Management, Elsevier, vol. 103(C).
    15. Ghosh, Prasenjit & Rong, Jian & Khanna, Madhu & Wang, Weiwei & Miao, Ruiqing, 2017. "Have They Gone with the Wind? Indirect Effects of Wind Turbines on Bird Abundance," 2017 Annual Meeting, July 30-August 1, Chicago, Illinois 258100, Agricultural and Applied Economics Association.
    16. Mullahy, John, 2024. "Analyzing health outcomes measured as bounded counts," Journal of Health Economics, Elsevier, vol. 95(C).
    17. Michel Beine & Ilan Noy & Christopher Parsons, 2021. "Climate change, migration and voice," Climatic Change, Springer, vol. 167(1), pages 1-27, July.
    18. Christian Kleiber & Achim Zeileis, 2016. "Visualizing Count Data Regressions Using Rootograms," The American Statistician, Taylor & Francis Journals, vol. 70(3), pages 296-303, July.
    19. M. Antonini & R. C. van Kleef & J. Henriquez & F. Paolucci, 2023. "Can risk rating increase the ability of voluntary deductibles to reduce moral hazard?," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 48(1), pages 130-156, January.
    20. D M Zimmer, 2023. "The effect of food stamps on fibre intake," Economic Issues Journal Articles, Economic Issues, vol. 28(2), pages 71-86, September.

    More about this item

    Statistics

    Access and download statistics

    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:spr:aphecp:v:14:y:2016:i:5:d:10.1007_s40258-016-0251-4. 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: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    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.