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The use of cost-sharing to control demand and the implications for equity: some theoretical and empirical evidence for Italy

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  • Rosalba Rombaldoni

    (Department of Economics, Society & Politics, Università di Urbino "Carlo Bo")

Abstract

The existence of barriers to access to health care depends in the complex interaction of supply and demand-side factors, and both these factors will determine the extent to which access is equitable, based on the principle of equal utilization for equal need. Among these barriers we have cost-sharing that represents a well established tool to control demand, in many OECD countries. Many contributions in literature highlight arguments pro and against user charges: on one side, advocates of them claim that they can reduce demand by encouraging a more responsible useof health services, and raise revenue to sustain and expand the provision of health care, on the other side there is some evidence suggesting that they have a detrimental effect on the utilization of health services, and by extension on health status. The aim of the paper is to assess the extent to which the imposition of statutory user charges deter individuals from using health services and whether they result in health care systems characterized by unequal utilization for equal need. A special attention is given to the case of Italy, where tickets rules have been piling up in recent years, we do have some evidence of inequity of access and a stronger regional autonomy due to the process of federalism could exacerbate local disparities in access to essential assistance level. Can tickets have a positive role in this scenario? A moderate level, coupled with right exemption schemes seems to induce positive effects for equity, with the possibility of widening the range of health services within the public coverage and preserving the distributional function of the national health system.

Suggested Citation

  • Rosalba Rombaldoni, 2012. "The use of cost-sharing to control demand and the implications for equity: some theoretical and empirical evidence for Italy," Working Papers 1211, University of Urbino Carlo Bo, Department of Economics, Society & Politics - Scientific Committee - L. Stefanini & G. Travaglini, revised 2012.
  • Handle: RePEc:urb:wpaper:12_11
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    File URL: http://www.econ.uniurb.it/RePEc/urb/wpaper/WP_12_11.pdf
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    References listed on IDEAS

    as
    1. Martin Chalkley;Ray Robinson, 1997. "Theory and Evidence on Cost Sharing in Health Care: An Economic Perspective," Monograph 000429, Office of Health Economics.
    2. Evans, R.G. & Barer, M.L., 1995. "User Fees for Health Care: Why a Bad Idea Keeps Coming Back (Or, What's Health Got to Do with It?)," Centre for Health Services and Policy Research 95:8r, University of British Columbia - Centre for Health Services and Policy Research..
    3. Lurie, N. & Kamberg, C.J. & Brook, R.H. & Keeler, E.B. & Newhouse, J.P., 1989. "How free care improved vision in the health insurance experiment," American Journal of Public Health, American Public Health Association, vol. 79(5), pages 640-642.
    4. Zeckhauser, Richard, 1970. "Medical insurance: A case study of the tradeoff between risk spreading and appropriate incentives," Journal of Economic Theory, Elsevier, vol. 2(1), pages 10-26, March.
    5. Pauly, Mark V. & Blavin, Fredric E., 2008. "Moral hazard in insurance, value-based cost sharing, and the benefits of blissful ignorance," Journal of Health Economics, Elsevier, vol. 27(6), pages 1407-1417, December.
    6. Manning, Willard G. & Marquis, M. Susan, 1996. "Health insurance: The tradeoff between risk pooling and moral hazard," Journal of Health Economics, Elsevier, vol. 15(5), pages 609-639, October.
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    Cited by:

    1. Nikolaos Grigorakis & Christos Floros & Haritini Tsangari & Evangelos Tsoukatos, 2017. "Combined social and private health insurance versus catastrophic out of pocket payments for private hospital care in Greece," International Journal of Health Economics and Management, Springer, vol. 17(3), pages 261-287, September.

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    More about this item

    Keywords

    Cost-sharing; Equity in access; Health care demand; Tickets in Italy.;
    All these keywords.

    JEL classification:

    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • H77 - Public Economics - - State and Local Government; Intergovernmental Relations - - - Intergovernmental Relations; Federalism
    • D63 - Microeconomics - - Welfare Economics - - - Equity, Justice, Inequality, and Other Normative Criteria and Measurement

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