IDEAS home Printed from https://ideas.repec.org/a/spr/hecrev/v6y2016i1d10.1186_s13561-016-0105-7.html
   My bibliography  Save this article

The abolition of user charges and the demand for ambulatory visits: evidence from the Czech Republic

Author

Listed:
  • Jana Votapkova

    (Charles University)

  • Pavlina Zilova

    (Charles University)

Abstract

This paper estimates the effect of the abolition of user charges for children’s outpatient care (30 CZK/1.2 EUR) in 2009 on the demand for ambulatory doctor visits in the Czech Republic. Because the reform applied only to children, we can employ the difference-in-differences approach, where children constitute a treatment group and adults serve as a control group. The dataset covers 1841 observations. Aside from the treatment effect, we control for a number of personal characteristics using micro-level data (European Union Statistics on Income and Living Conditions). Using the zero-inflated negative binomial model, we found no significant effect from the abolition of user charges on doctor visits, suggesting either that user charges are ineffective in the Czech environment or that their value was set too low. On the contrary, personal income, the number of household members and gender have a significant effect. A number of robustness checks using restricted samples confirm the results.

Suggested Citation

  • Jana Votapkova & Pavlina Zilova, 2016. "The abolition of user charges and the demand for ambulatory visits: evidence from the Czech Republic," Health Economics Review, Springer, vol. 6(1), pages 1-11, December.
    • Handle: RePEc:spr:hecrev:v:6:y:2016:i:1:d:10.1186_s13561-016-0105-7
    DOI: 10.1186/s13561-016-0105-7
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1186/s13561-016-0105-7
    File Function: Abstract
    Download Restriction: no
    File URL: https://libkey.io/10.1186/s13561-016-0105-7?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
    ---><---

    References listed on IDEAS

    as
    1. Jan Zápal, 2010. "Doctor-Visit Co-Payment Exemption for Children: First Look at the Data," Czech Journal of Economics and Finance (Finance a uver), Charles University Prague, Faculty of Social Sciences, vol. 60(1), pages 58-72, February.
    2. Lundberg, Lena & Johannesson, Magnus & Isacson, Dag G. L. & Borgquist, Lars, 1998. "Effects of user charges on the use of prescription medicines in different socio-economic groups," Health Policy, Elsevier, vol. 44(2), pages 123-134, May.
    3. Rainer Winkelmann, 2004. "Co‐payments for prescription drugs and the demand for doctor visits – Evidence from a natural experiment," Health Economics, John Wiley & Sons, Ltd., vol. 13(11), pages 1081-1089, November.
    4. van Doorslaer, Eddy & Wagstaff, Adam & van der Burg, Hattem & Christiansen, Terkel & De Graeve, Diana & Duchesne, Inge & Gerdtham, Ulf-G & Gerfin, Michael & Geurts, Jose & Gross, Lorna, 2000. "Equity in the delivery of health care in Europe and the US," Journal of Health Economics, Elsevier, vol. 19(5), pages 553-583, September.
    5. Chiappori, Pierre-Andre & Durand, Franck & Geoffard, Pierre-Yves, 1998. "Moral hazard and the demand for physician services: First lessons from a French natural experiment," European Economic Review, Elsevier, vol. 42(3-5), pages 499-511, May.
    6. Bauer, Thomas & Augurzky, Boris & Schaffner, Sandra, 2006. "Copayments in the German Health System - Does it Work?," CEPR Discussion Papers 5869, C.E.P.R. Discussion Papers.
    7. J. Scott Long & Jeremy Freese, 2006. "Regression Models for Categorical Dependent Variables using Stata, 2nd Edition," Stata Press books, StataCorp LP, edition 2, number long2, March.
    8. Schreyögg, Jonas & Grabka, Markus M., 2010. "Copayments for Ambulatory Care in Germany: A Natural Experiment Using a Difference-in-Difference Approach," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 11(3), pages 331-341.
    9. 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.
    10. van Wijk, Cecile M.T.Gijsbers & Kolk, Annemarie M. & van Den Bosch, Wil J.H.M. & Van Den Hoogen, Henk J.M., 1992. "Male and female morbidity in general practice: The nature of sex differences," Social Science & Medicine, Elsevier, vol. 35(5), pages 665-678, September.
    11. Kan, Mari & Suzuki, Wataru, 2010. "Effects of cost sharing on the demand for physician services in Japan: Evidence from a natural experiment," Japan and the World Economy, Elsevier, vol. 22(1), pages 1-12, January.
    12. Cockx, Bart & Brasseur, Carine, 2003. "The demand for physician services: Evidence from a natural experiment," Journal of Health Economics, Elsevier, vol. 22(6), pages 881-913, November.
    13. 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.
    14. Baji, Petra & Pavlova, Milena & Gulácsi, LászlÓ & Groot, Wim, 2011. "User fees for public health care services in Hungary: Expectations, experience, and acceptability from the perspectives of different stakeholders," Health Policy, Elsevier, vol. 102(2), pages 255-262.
    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. Camilla Beck Olsen & Hans Olav Melberg, 2018. "Did adolescents in Norway respond to the elimination of copayments for general practitioner services?," Health Economics, John Wiley & Sons, Ltd., vol. 27(7), pages 1120-1130, July.
    2. 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.

    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. Astrid Kiil & Kurt Houlberg, 2014. "How does copayment for health care services affect demand, health and redistribution? A systematic review of the empirical evidence from 1990 to 2011," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(8), pages 813-828, November.
    2. Ha Trong Nguyen & Luke B Connelly, 2017. "Cost-sharing in health insurance and its impact in a developing country: evidence from a quasi-natural experiment," Bankwest Curtin Economics Centre Working Paper series WP1702, Bankwest Curtin Economics Centre (BCEC), Curtin Business School.
    3. 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.
    4. Takaku, Reo, 2017. "The Effect Of Patient Cost Sharing On Health Care Utilization Among Low-Income Children," Hitotsubashi Journal of Economics, Hitotsubashi University, vol. 58(1), pages 69-88, June.
    5. Jakobsson, Niklas & Svensson, Mikael, 2016. "Copayments and physicians visits: A panel data study of Swedish regions 2003–2012," Health Policy, Elsevier, vol. 120(9), pages 1095-1099.
    6. 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.
    7. Schmitz, Hendrik, 2013. "Practice budgets and the patient mix of physicians – The effect of a remuneration system reform on health care utilisation," Journal of Health Economics, Elsevier, vol. 32(6), pages 1240-1249.
    8. 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.
    9. Nicolas Ziebarth, 2014. "Assessing the effectiveness of health care cost containment measures: evidence from the market for rehabilitation care," International Journal of Health Economics and Management, Springer, vol. 14(1), pages 41-67, March.
    10. Mas, Nuria & Cirera, Laia & Viñolas, Guillem, 2011. "Los sistemas de copago en Europa, Estados Unidos y Canadá: Implicaciones para el caso español," IESE Research Papers D/939, IESE Business School.
    11. Lee Yong-Woo & Lee Yong-Ju, 2019. "The Effects of Copayments on Healthcare Utilization in Korea’s Medical Aid Program," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 19(3), pages 1-17, July.
    12. Trottmann, Maria & Zweifel, Peter & Beck, Konstantin, 2012. "Supply-side and demand-side cost sharing in deregulated social health insurance: Which is more effective?," Journal of Health Economics, Elsevier, vol. 31(1), pages 231-242.
    13. 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.
    14. Hudson, Eibhlin & Nolan, Anne, 2015. "Public healthcare eligibility and the utilisation of GP services by older people in Ireland," The Journal of the Economics of Ageing, Elsevier, vol. 6(C), pages 24-43.
    15. NicolasR. Ziebarth, 2010. "Estimating Price Elasticities of Convalescent Care Programmes," Economic Journal, Royal Economic Society, vol. 120(545), pages 816-844, June.
    16. Jianmei Zhao & Hai Zhong, 2015. "Medical expenditure in urban China: a quantile regression analysis," International Journal of Health Economics and Management, Springer, vol. 15(4), pages 387-406, December.
    17. Nicolas R. Ziebarth, 2009. ""Do I Really Need to Go to Rehab? I'd Say No, No, No.": Estimating Price Elasticities of Convalescent Care Programs," Discussion Papers of DIW Berlin 910, DIW Berlin, German Institute for Economic Research.
    18. Hendrik Schmitz, 2012. "More health care utilization with more insurance coverage? Evidence from a latent class model with German data," Applied Economics, Taylor & Francis Journals, vol. 44(34), pages 4455-4468, December.
    19. 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.

    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:hecrev:v:6:y:2016:i:1:d:10.1186_s13561-016-0105-7. 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/economics/journal/13561 .

    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.