The use of cost-sharing to control demand and the implications for equity: some theoretical and empirical evidence for Italy
AbstractThe 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.
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Bibliographic InfoPaper provided by University of Urbino Carlo Bo, Department of Economics, Society & Politics - Scientific Committee - L. Stefanini & G. Travaglini in its series Working Papers with number 1211.
Length: 20 pages
Date of creation: 2012
Date of revision: 2012
Cost-sharing; Equity in access; Health care demand; Tickets in Italy.;
Find related papers by 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
This paper has been announced in the following NEP Reports:
- NEP-ALL-2012-08-23 (All new papers)
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- 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.
- 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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