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The Impact of an Increase in User Costs on the Demand for Emergency Services: The Case of Portuguese Hospitals

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  • Pedro Ramos
  • Alvaro Almeida

Abstract

Evidence on the impact of user costs on healthcare demand in ‘universal’ public National Health Services (NHS) is scarce. The changes in copayments and in the regulation of the provision of free patient transportation, introduced in early 2012 in Portugal, provide a natural experiment to evaluate that impact. However, those changes in user costs were accompanied with changes in the criteria that determine which patients are exempt from copayments, implying that simple comparisons of user rates would be biased. In this paper, we develop a new methodology to evaluate the impact of increases in direct and indirect user costs on the demand for emergency services (ES) in the presence of compositional changes in co‐payment exempt and non‐exempt populations. Our results show that the increase in copayments did not have an effect in moderating ES demand by paying users, but we find significant effects of the change in transport regulation. Thus, our results support the conclusion that indirect costs may be more important than direct costs in determining healthcare demand in NHS‐countries where copayments are small and wide exemption schemes are in place, especially for older patients. Copyright © 2015 John Wiley & Sons, Ltd.

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  • Pedro Ramos & Alvaro Almeida, 2016. "The Impact of an Increase in User Costs on the Demand for Emergency Services: The Case of Portuguese Hospitals," Health Economics, John Wiley & Sons, Ltd., vol. 25(11), pages 1372-1388, November.
    • Handle: RePEc:wly:hlthec:v:25:y:2016:i:11:p:1372-1388
    DOI: 10.1002/hec.3223
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    1. Acton, Jan Paul, 1975. "Nonmonetary Factors in the Demand for Medical Services: Some Empirical Evidence," Journal of Political Economy, University of Chicago Press, vol. 83(3), pages 595-614, June.
    2. 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.
    3. Óscar D. Lourenço & Pedro L. Ferreira, 2005. "Utilization of public health centres in Portugal: effect of time costs and other determinants. Finite mixture models applied to truncated samples," Health Economics, John Wiley & Sons, Ltd., vol. 14(9), pages 939-953, September.
    4. Ann D. Colle & Michael Grossman, 1978. "Determinants of Pediatric Care Utilization," NBER Chapters, in: The Economics of Physician and Patient Behavior, pages 115-158, National Bureau of Economic Research, Inc.
    5. Barros, Pedro Pita, 2012. "Health policy reform in tough times: The case of Portugal," Health Policy, Elsevier, vol. 106(1), pages 17-22.
    6. Ai, Chunrong & Norton, Edward C., 2003. "Interaction terms in logit and probit models," Economics Letters, Elsevier, vol. 80(1), pages 123-129, July.
    7. Seung‐Hyun Hong, 2013. "Measuring The Effect Of Napster On Recorded Music Sales: Difference‐In‐Differences Estimates Under Compositional Changes," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 28(2), pages 297-324, March.
    8. Jaume Puig‐Junoy & Marc Saez & Esther Martínez‐García, 1998. "Why do patients prefer hospital emergency visits? A nested multinomial logit analysis for patient‐initiated contacts," Health Care Management Science, Springer, vol. 1(1), pages 39-52, September.
    9. 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.
    10. Duarte, Fabian, 2012. "Price elasticity of expenditure across health care services," Journal of Health Economics, Elsevier, vol. 31(6), pages 824-841.
    11. Dor, Avi & Gertler, Paul & van der Gaag, Jacques, 1987. "Non-price rationing and the choice of medical care providers in rural Cote d'Ivoire," Journal of Health Economics, Elsevier, vol. 6(4), pages 291-304, December.
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    1. Chen, Wen-Yi, 2020. "The welfare effect of co-payment adjustments on emergency department visits in medical centers: Evidence from Taiwan," Health Policy, Elsevier, vol. 124(11), pages 1192-1199.
    2. Álvaro S Almeida & Joana Vales, 2017. "Models Of Primary Care Organization And The Use Of Emergency Departments," FEP Working Papers 598, Universidade do Porto, Faculdade de Economia do Porto.

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