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Effects of primary care cost-sharing among young adults: varying impact across income groups and gender

Author

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  • Naimi Johansson

    (Health Metrics, Sahlgrenska Academy at University of Gothenburg)

  • Niklas Jakobsson

    (Karlstad University
    Norwegian Social Research (NOVA))

  • Mikael Svensson

    (Health Metrics, Sahlgrenska Academy at University of Gothenburg)

Abstract

We estimate the price sensitivity in health care among adolescents and young adults, and assess how it varies across income groups and gender, using a regression discontinuity design. We use the age differential cost-sharing in Swedish primary care as our identification strategy. At the 20th birthday, the copayment increases from €0 to approx. €10 per primary care physician visit and close to this threshold the copayment faced by each person is distributed almost as good as if randomized. The analysis is performed using high-quality health care and economic register data of 73,000 individuals aged 18–22. Our results show that the copayment decreases the average number of visits by 7%. Among women visits are reduced by 9%, for low-income individuals by 11%, and for low-income women by 14%. In conclusion, modest copayments have significant utilization effects, and even in a policy context with relatively low income inequalities, the effect is substantially larger in low-income groups and among women.

Suggested Citation

  • Naimi Johansson & Niklas Jakobsson & Mikael Svensson, 2019. "Effects of primary care cost-sharing among young adults: varying impact across income groups and gender," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(8), pages 1271-1280, November.
  • Handle: RePEc:spr:eujhec:v:20:y:2019:i:8:d:10.1007_s10198-019-01095-6
    DOI: 10.1007/s10198-019-01095-6
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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. Ellegård, Lina Maria & Kjellsson, Gustav & Mattisson, Linn, 2021. "An App Call a Day Keeps the Patient Away? Substitution of Online and In-Person Doctor Consultations Among Young Adults," Working Papers in Economics 808, University of Gothenburg, Department of Economics, revised May 2022.
    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. 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).
    5. 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.
    6. Hirotaka Kato & Rei Goto & Taishi Tsuji & Katsunori Kondo, 2022. "The effects of patient cost-sharing on health expenditure and health among older people: Heterogeneity across income groups," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(5), pages 847-861, July.
    7. 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).
    8. Haaga, Tapio & Böckerman, Petri & Kortelainen, Mika & Tukiainen, Janne, 2024. "Effects of nurse visit copayment on primary care use: Do low-income households pay the price?," Journal of Health Economics, Elsevier, vol. 94(C).

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    More about this item

    Keywords

    Patient cost-sharing; Health care demand; Price sensitivity; Income inequality;
    All these keywords.

    JEL classification:

    • D12 - Microeconomics - - Household Behavior - - - Consumer Economics: Empirical Analysis
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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