Co-payment exemption and healthcare consumption. Quasi-experimental evidence from Italy

This paper investigates the causal effect of co-payment exemption on the utilization of healthcare services with a particular emphasis on the number of specialist visits in the Italian National Health System (NHS). As the co-payment exemption may be considered as a sort of insurance, a relevant research question is to ask whether such a protection has had any effect on healthcare services utilization. Exploiting a discontinuity in the multiple eligibility criteria for co-payment exemption, we apply Multiple Regression Discontinuity (MRD) in a quasi-experimental setting, considering both age and income requirements.This discontinuity also allows us to identify the effect of co-payment on a particularly fragile sub-population of less wealthy people. Our findings provide convincing evidence of a positive and significant effect of co-payment exemption on the number of specialist visits. The result may be useful to the policy maker to tailor ad-hoc policies aimed at disadvantaged sub-populations.