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Evaluating the impact of eligibility for free care on the use of general practitioner (GP) services: A difference-in-difference matching approach

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  • Nolan, Anne

Abstract

In Ireland, approximately 30% of the population ('medical card patients') are entitled to free general practitioner (GP) care while the remaining 70% ('private patients') must pay the full cost of each visit. Previous research has analysed the effect of this system on GP visiting patterns using regression methods, but to date, no attempt has been made to apply techniques from the treatment evaluation literature to this issue. Treatment evaluation techniques are commonly employed when observations are not randomly assigned to treatment and control groups; this is certainly the case here, as the primary criterion for medical card eligibility is an income below a specified income threshold (and individuals may also be granted medical cards for other reasons such as chronic ill-health). In this paper, previous Irish research, which has analysed the effect of medical card eligibility on GP visiting using regression methods, is extended to consider the use of difference-in-difference matching methods, which control for non-random selection into treatment and control groups, as well as differences in time-invariant unobserved characteristics between individuals in both groups. The results are largely consistent with earlier results using pooled cross-sectional and panel data, and confirm that medical card eligibility exerts a significant effect on GP visiting, even after controlling for observed and unobserved differences in characteristics between medical card and private patients.

Suggested Citation

  • Nolan, Anne, 2008. "Evaluating the impact of eligibility for free care on the use of general practitioner (GP) services: A difference-in-difference matching approach," Social Science & Medicine, Elsevier, vol. 67(7), pages 1164-1172, October.
  • Handle: RePEc:eee:socmed:v:67:y:2008:i:7:p:1164-1172
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    References listed on IDEAS

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    Citations

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    Cited by:

    1. Richard Layte & Anne Nolan, 2015. "Eligibility for free GP care and the utilisation of GP services by children in Ireland," International Journal of Health Economics and Management, Springer, vol. 15(1), pages 3-27, March.
    2. Nolan, Anne, 2011. "An extension in eligibility for free primary care and avoidable hospitalisations: A natural experiment," Social Science & Medicine, Elsevier, pages 978-985.
    3. Connolly, Sheelah & Wren, Maev-Ann, 2017. "Unmet healthcare needs in Ireland: Analysis using the EU-SILC survey," Health Policy, Elsevier, vol. 121(4), pages 434-441.
    4. Astrid Kiil & Kurt Houlberg, 2014. "How does copayment for health care services affect demand, health and redistribution? A systematic review of the empirical evidence from 1990 to 2011," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(8), pages 813-828, November.
    5. Connolly, Sheelah & Wren, Maev-Ann, 2016. "The 2011 proposal for Universal Health Insurance in Ireland: Potential implications for healthcare expenditure," Health Policy, Elsevier, vol. 120(7), pages 790-796.
    6. Richard Layte & Anne Nolan, 2015. "Income-related inequity in the use of GP services by children: a comparison of Ireland and Scotland," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(5), pages 489-506, June.
    7. Fiorentini, Gianluca & Lippi Bruni, Matteo & Ugolini, Cristina, 2013. "GPs and hospital expenditures. Should we keep expenditure containment programs alive?," Social Science & Medicine, Elsevier, pages 10-20.
    8. Poulsen, Camilla Aavang, 2014. "Introducing out-of-pocket payment for General Practice in Denmark: Feasibility and support," Health Policy, Elsevier, vol. 117(1), pages 64-71.
    9. Fiorentini, Gianluca & Lippi Bruni, Matteo & Ugolini, Cristina, 2013. "GPs and hospital expenditures. Should we keep expenditure containment programs alive?," Social Science & Medicine, Elsevier, pages 10-20.
    10. Layte, Richard & Nolan, Anne & McGee, Hannah & O'Hanlon, Ann, 2009. "Do consultation charges deter general practitioner use among older people? A natural experiment," Social Science & Medicine, Elsevier, vol. 68(8), pages 1432-1438, April.

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