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The effects of copayment in primary health care: evidence from a natural experiment

Author

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  • Laia Maynou

    (London School of Economics and Political Science (LSE)
    Universitat Pompeu Fabra
    University of Girona
    CIBER of Epidemiology and Public Health (CIBERESP))

  • Gabriel Coll-de-Tuero

    (CIBER of Epidemiology and Public Health (CIBERESP)
    Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol)
    University of Girona)

  • Marc Saez

    (Universitat Pompeu Fabra
    University of Girona
    CIBER of Epidemiology and Public Health (CIBERESP))

Abstract

Objective Evaluate the effects of the ‘euro per prescription’ on primary health care services (number of doctor visits), through a retrospective cohort study of health care users in Catalonia (Spain). This policy, implemented in Catalonia on 23 June 2012, only lasted 6 months. This policy was introduced to improve budgetary imbalances in Spain and boost the regional and national governments’ budgets. Methods We used a retrospective cohort, composed of individuals who had had contact with primary healthcare services between January 1, 2005 and December 31, 2012. The econometric specification followed is a hurdle model. Results Our results show that from October 2012 onwards there was a decrease in the average number of overall visits, particularly for individuals aged 65 years or more. However, this decline cannot be entirely attributed to the introduction of the euro per prescription policy as in October of that same year the Spanish government introduced its pharmaceutical copayment for pensioners. Conclusions The policies appraised in this paper reveal a clear deterrent effect among vulnerable individuals such as those with the highest probability of being unemployed and/or those individuals with chronic conditions.

Suggested Citation

  • Laia Maynou & Gabriel Coll-de-Tuero & Marc Saez, 2019. "The effects of copayment in primary health care: evidence from a natural experiment," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(8), pages 1237-1248, November.
    • Handle: RePEc:spr:eujhec:v:20:y:2019:i:8:d:10.1007_s10198-019-01089-4
    DOI: 10.1007/s10198-019-01089-4
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    Cited by:

    1. Berger, Michael & Six, Eva & Czypionka, Thomas, 2024. "Policy implications of heterogeneous demand reactions to changes in cost-sharing: patient-level evidence from Austria," LSE Research Online Documents on Economics 121162, London School of Economics and Political Science, LSE Library.
    2. Antonio Palazón-Bru & Miriam Calvo-Pérez & Pilar Rico-Ferreira & María Anunciación Freire-Ballesta & Vicente Francisco Gil-Guillén & María de los Ángeles Carbonell-Torregrosa, 2021. "Influence of Pharmaceutical Copayment on Emergency Hospital Admissions: A 1978–2018 Time Series Analysis in Spain," IJERPH, MDPI, vol. 18(15), pages 1-12, July.
    3. Berger, Michael & Six, Eva & Czypionka, Thomas, 2024. "Policy implications of heterogeneous demand reactions to changes in cost-sharing: Patient-level evidence from Austria," Social Science & Medicine, Elsevier, vol. 340(C).
    4. O’Brien, Gary L. & Sinnott, Sarah-Jo & O’ Flynn, Bridget & Walshe, Valerie & Mulcahy, Mark & Byrne, Stephen, 2020. "Out of pocket or out of control: A qualitative analysis of healthcare professional stakeholder involvement in pharmaceutical policy change in Ireland," Health Policy, Elsevier, vol. 124(4), pages 411-418.

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    More about this item

    Keywords

    ‘Euro per prescription’; Cohorts; Hurdle model; Mixed models;
    All these keywords.

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • C50 - Mathematical and Quantitative Methods - - Econometric Modeling - - - General
    • C11 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods and Methodology: General - - - Bayesian Analysis: General
    • H71 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Taxation, Subsidies, and Revenue

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