IDEAS home Printed from https://ideas.repec.org/p/urb/wpaper/12_11.html
   My bibliography  Save this paper

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

Author

Listed:
  • 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
    as

    Download full text from publisher

    File URL: http://www.econ.uniurb.it/RePEc/urb/wpaper/WP_12_11.pdf
    File Function: First version, 2012
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. 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.
    2. 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.
    3. Martin Chalkley;Ray Robinson, 1997. "Theory and Evidence on Cost Sharing in Health Care: An Economic Perspective," Monograph 000429, Office of Health Economics.
    4. 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.
    5. 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..
    6. 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.
    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. 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.

    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. Jacques Drèze & Erik Schokkaert, 2013. "Arrow’s theorem of the deductible: Moral hazard and stop-loss in health insurance," Journal of Risk and Uncertainty, Springer, vol. 47(2), pages 147-163, October.
    2. Michael Drummond & Adrian Towse, 2012. "Is it time to reconsider the role of patient co-payments for pharmaceuticals in Europe?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(1), pages 1-5, February.
    3. Westerhout, Ed & Folmer, Kees, 2018. "The Effects of Capping Co-Insurance Payments," Other publications TiSEM 828746fb-4fb0-465b-bdff-3, Tilburg University, School of Economics and Management.
    4. Westerhout, Ed & Folmer, Kees, 2018. "The Effects of Capping Co-Insurance Payments," Discussion Paper 2018-050, Tilburg University, Center for Economic Research.
    5. Boone, Jan, 2015. "Basic versus supplementary health insurance: Moral hazard and adverse selection," Journal of Public Economics, Elsevier, vol. 128(C), pages 50-58.
    6. Boone, J., 2014. "Basic Versus Supplementary Health Insurance : Moral Hazard and Adverse Selection," Other publications TiSEM 8ad45428-2ab4-406f-bbd3-3, Tilburg University, School of Economics and Management.
    7. Ellis, Randall P. & Manning, Willard G., 2007. "Optimal health insurance for prevention and treatment," Journal of Health Economics, Elsevier, vol. 26(6), pages 1128-1150, December.
    8. Landsem, Mari Magnussen & Magnussen, Jon, 2018. "The effect of copayments on the utilization of the GP service in Norway," Social Science & Medicine, Elsevier, vol. 205(C), pages 99-106.
    9. Cutler, David M. & Zeckhauser, Richard J., 2000. "The anatomy of health insurance," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 11, pages 563-643, Elsevier.
    10. Blomqvist, Ake, 2001. "Does the economics of moral hazard need to be revisited? A comment on the paper by John Nyman," Journal of Health Economics, Elsevier, vol. 20(2), pages 283-288, March.
    11. Ellis, Randall P. & Jiang, Shenyi & Manning, Willard G., 2015. "Optimal health insurance for multiple goods and time periods," Journal of Health Economics, Elsevier, vol. 41(C), pages 89-106.
    12. Mamas Theodorou, 2014. "Testing the Waters for GeSY: Patients’ Opinion of Cost-sharing Arrangements in the Public Health Care System in Cyprus," Cyprus Economic Policy Review, University of Cyprus, Economics Research Centre, vol. 8(2), pages 37-59, December.
    13. Katherine Baicker & Sendhil Mullainathan & Joshua Schwartzstein, 2015. "Behavioral Hazard in Health Insurance," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 130(4), pages 1623-1667.
    14. Crown William H. & Berndt Ernst R. & Baser Onur & Finkelstein Stan N. & Witt Whitney P. & Maguire Jonathan & Haver Kenan E., 2004. "Benefit Plan Design and Prescription Drug Utilization Among Asthmatics: Do Patient Copayments Matter?," Forum for Health Economics & Policy, De Gruyter, vol. 7(1), pages 1-35, January.
    15. Folmer, Cees & Westerhout, Ed, 2008. "Financing medical specialist services in The Netherlands: Welfare implications of imperfect agency," Economic Modelling, Elsevier, vol. 25(5), pages 946-958, September.
    16. Basu, Anirban, 2015. "Welfare implications of learning through solicitation versus diversification in health care," Journal of Health Economics, Elsevier, vol. 42(C), pages 165-173.
    17. Kowalski, Amanda E., 2015. "Estimating the tradeoff between risk protection and moral hazard with a nonlinear budget set model of health insurance," International Journal of Industrial Organization, Elsevier, vol. 43(C), pages 122-135.
    18. Jung, Juergen & Tran, Chung, 2022. "Social health insurance: A quantitative exploration," Journal of Economic Dynamics and Control, Elsevier, vol. 139(C).
    19. Glazer, Jacob & McGuire, Thomas G., 2012. "A welfare measure of “offset effects” in health insurance," Journal of Public Economics, Elsevier, vol. 96(5), pages 520-523.
    20. 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.

    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

    Statistics

    Access and download statistics

    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:urb:wpaper:12_11. 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: Carmela Nicoletti (email available below). General contact details of provider: https://edirc.repec.org/data/feurbit.html .

    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.