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Limited Means, Limited Care? Healthcare Expenditures of the Financially Constrained in the Netherlands

Mats Frijlink, Minke Remmerswaal, Jan Boone, Lily Davies and Rudy Douven

No 21605, CEPR Discussion Papers from Centre for Economic Policy Research

Abstract: Financially constrained people may reduce their healthcare use due to out-of-pocket payments and other costs or barriers. We combine rich survey and administrative data from the Netherlands, linking individuals' reported financial difficulties with detailed records on income, wealth, health status, and healthcare expenditures. We find that, after controlling for health status, individuals with low financial wealth who struggle to make ends meet spend substantially and significantly less on curative care than those without such constraints. No such pattern is found for general practitioner visits, which are exempt from cost-sharing. Our findings indicate that financially constrained individuals are disproportionately sensitive to cost-sharing, which may reduce access to care.

Date: 2026-06
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