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Patient cost-sharing, socioeconomic status, and children's health care utilization

Anton Nilsson and Alexander Paul

Journal of Health Economics, 2018, vol. 59, issue C, 109-124

Abstract: This paper estimates the effect of cost-sharing on the demand for children's and adolescents’ use of medical care. We use a large population-wide registry dataset including detailed information on contacts with the health care system as well as family income. Two different estimation strategies are used: regression discontinuity design exploiting age thresholds above which fees are charged, and difference-in-differences models exploiting policy changes. We also estimate combined regression discontinuity difference-in-differences models that take into account discontinuities around age thresholds caused by factors other than cost-sharing. We find that when care is free of charge, individuals increase their number of doctor visits by 5–10%. Effects are similar in middle childhood and adolescence, and are driven by those from low-income families. The differences across income groups cannot be explained by other factors that correlate with income, such as maternal education.

Keywords: Cost-sharing; Health care utilization; Children; Income-health gradient; Difference-in-differences; Regression discontinuity (search for similar items in EconPapers)
JEL-codes: I13 I14 I18 (search for similar items in EconPapers)
Date: 2018
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Persistent link: https://EconPapers.repec.org/RePEc:eee:jhecon:v:59:y:2018:i:c:p:109-124

DOI: 10.1016/j.jhealeco.2018.03.006

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Journal of Health Economics is currently edited by J. P. Newhouse, A. J. Culyer, R. Frank, K. Claxton and T. McGuire

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