IDEAS home Printed from https://ideas.repec.org/a/spr/empeco/v67y2024i1d10.1007_s00181-023-02552-1.html
   My bibliography  Save this article

Co-payment exemption and healthcare consumption: quasi-experimental evidence from Italy

Author

Listed:
  • Vanessa Cirulli

    (Sapienza University of Rome)

  • Giuliano Resce

    (University of Molise)

  • Marco Ventura

    (Sapienza University of Rome)

Abstract

This paper investigates the causal effect of co-payment exemption on the number of specialist visits in the Italian National Health System. Exploiting a discontinuity in the multiple eligibility criteria, we apply multiple regression discontinuity in a quasi-experimental setting, considering both age and income requirements. Differently from the standard regression discontinuity, this twofold discontinuity allows to identify the effect of co-payment on a particularly needy sub-population of less wealthy people and how it changes according to the eligibility criteria. We find positive effects of co-payment exemption and the effects are stronger for less wealthy and older individuals. The result may be useful to the policy maker to tailor ad-hoc policies aimed at disadvantaged sub-populations.

Suggested Citation

  • Vanessa Cirulli & Giuliano Resce & Marco Ventura, 2024. "Co-payment exemption and healthcare consumption: quasi-experimental evidence from Italy," Empirical Economics, Springer, vol. 67(1), pages 355-380, July.
  • Handle: RePEc:spr:empeco:v:67:y:2024:i:1:d:10.1007_s00181-023-02552-1
    DOI: 10.1007/s00181-023-02552-1
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s00181-023-02552-1
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.

    File URL: https://libkey.io/10.1007/s00181-023-02552-1?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to look for a different version below or search for a different version of it.

    Other versions of this item:

    References listed on IDEAS

    as
    1. Carine Van De Voorde & Eddy Van Doorslaer & Erik Schokkaert, 2001. "Effects of cost sharing on physician utilization under favourable conditions for supplier‐induced demand," Health Economics, John Wiley & Sons, Ltd., vol. 10(5), pages 457-471, July.
    2. repec:dau:papers:123456789/7402 is not listed on IDEAS
    3. Bernal, Noelia & Carpio, Miguel A. & Klein, Tobias J., 2017. "The effects of access to health insurance: Evidence from a regression discontinuity design in Peru," Journal of Public Economics, Elsevier, vol. 154(C), pages 122-136.
    4. Ponzo, Michela & Scoppa, Vincenzo, 2021. "Does demand for health services depend on cost-sharing? Evidence from Italy," Economic Modelling, Elsevier, vol. 103(C).
    5. Aviva Aron-Dine & Liran Einav & Amy Finkelstein, 2013. "The RAND Health Insurance Experiment, Three Decades Later," Journal of Economic Perspectives, American Economic Association, vol. 27(1), pages 197-222, Winter.
    6. Badi H. Baltagi & Raffaele Lagravinese & Francesco Moscone & Elisa Tosetti, 2017. "Health Care Expenditure and Income: A Global Perspective," Health Economics, John Wiley & Sons, Ltd., vol. 26(7), pages 863-874, July.
    7. Paolo Liberati, 2015. "The World Distribution of Income And Its Inequality, 1970–2009," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 61(2), pages 248-273, June.
    8. Sebastian Calonico & Matias D. Cattaneo & Rocio Titiunik, 2014. "Robust Nonparametric Confidence Intervals for Regression‐Discontinuity Designs," Econometrica, Econometric Society, vol. 82, pages 2295-2326, November.
    9. Brian A. Jacob & Lars Lefgren, 2004. "Remedial Education and Student Achievement: A Regression-Discontinuity Analysis," The Review of Economics and Statistics, MIT Press, vol. 86(1), pages 226-244, February.
    10. Matias Cattaneo & Rocio Titiunik & Gonzalo Vazquez-Bare, 2019. "Power calculations for regression-discontinuity designs," Stata Journal, StataCorp LP, vol. 19(1), pages 210-245, March.
    11. Amy Finkelstein & Sarah Taubman & Bill Wright & Mira Bernstein & Jonathan Gruber & Joseph P. Newhouse & Heidi Allen & Katherine Baicker, 2012. "The Oregon Health Insurance Experiment: Evidence from the First Year," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 127(3), pages 1057-1106.
    12. Sebastian Calonico & Matias D Cattaneo & Max H Farrell, 2020. "Optimal bandwidth choice for robust bias-corrected inference in regression discontinuity designs," The Econometrics Journal, Royal Economic Society, vol. 23(2), pages 192-210.
    13. Angrist, Joshua D, 2001. "Estimations of Limited Dependent Variable Models with Dummy Endogenous Regressors: Simple Strategies for Empirical Practice," Journal of Business & Economic Statistics, American Statistical Association, vol. 19(1), pages 2-16, January.
    14. 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.
    15. Sebastian Calonico & Matias D. Cattaneo & Rocío Titiunik, 2015. "Optimal Data-Driven Regression Discontinuity Plots," Journal of the American Statistical Association, Taylor & Francis Journals, vol. 110(512), pages 1753-1769, December.
    16. Cherkin, Daniel C. & Grothaus, Louis & Wagner, Edward H., 1992. "Is magnitude of co-payment effect related to income? Using census data for health services research," Social Science & Medicine, Elsevier, vol. 34(1), pages 33-41, January.
    17. Susan Athey & Stefan Wager, 2021. "Policy Learning With Observational Data," Econometrica, Econometric Society, vol. 89(1), pages 133-161, January.
    18. Giuliano Resce & Raffaele Lagravinese & Elisa Benedetti & Sabrina Molinaro, 2019. "Income-related inequality in gambling: evidence from Italy," Review of Economics of the Household, Springer, vol. 17(4), pages 1107-1131, December.
    19. Battistin, Erich & Rettore, Enrico, 2008. "Ineligibles and eligible non-participants as a double comparison group in regression-discontinuity designs," Journal of Econometrics, Elsevier, vol. 142(2), pages 715-730, February.
    20. Philip Arestis & Ron Martin & Peter Tyler, 2011. "The Persistence of Inequality?," Cambridge Journal of Regions, Economy and Society, Cambridge Political Economy Society, vol. 4(1), pages 3-11.
    21. Melissa Dell, 2010. "The Persistent Effects of Peru's Mining Mita," Econometrica, Econometric Society, vol. 78(6), pages 1863-1903, November.
    22. Raffaele Lagravinese, 2015. "Economic crisis and rising gaps North–South: evidence from the Italian regions," Cambridge Journal of Regions, Economy and Society, Cambridge Political Economy Society, vol. 8(2), pages 331-342.
    23. Abadie, Alberto, 2003. "Semiparametric instrumental variable estimation of treatment response models," Journal of Econometrics, Elsevier, vol. 113(2), pages 231-263, April.
    24. Guido Imbens & Karthik Kalyanaraman, 2012. "Optimal Bandwidth Choice for the Regression Discontinuity Estimator," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 79(3), pages 933-959.
    25. Vincenzo Atella & Joanna Kopinska, 2014. "The impact of cost-sharing schemes on drug compliance in Italy: evidence based on quantile regression," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 59(2), pages 329-339, April.
    26. Yingying Dong & Arthur Lewbel, 2015. "Identifying the Effect of Changing the Policy Threshold in Regression Discontinuity Models," The Review of Economics and Statistics, MIT Press, vol. 97(5), pages 1081-1092, December.
    27. Cockx, Bart & Brasseur, Carine, 2003. "The demand for physician services: Evidence from a natural experiment," Journal of Health Economics, Elsevier, vol. 22(6), pages 881-913, November.
    28. Matias D. Cattaneo & Nicolas Idrobo & Rocio Titiunik, 2023. "A Practical Introduction to Regression Discontinuity Designs: Extensions," Papers 2301.08958, arXiv.org, revised Mar 2024.
    29. De Matteis, Domenico & Ishizaka, Alessio & Resce, Giuliano, 2019. "The ‘postcode lottery’ of the Italian public health bill analysed with the hierarchy Stochastic Multiobjective Acceptability Analysis," Socio-Economic Planning Sciences, Elsevier, vol. 68(C).
    30. Matias D. Cattaneo & Rocío Titiunik & Gonzalo Vazquez-Bare, 2020. "Analysis of regression-discontinuity designs with multiple cutoffs or multiple scores," Stata Journal, StataCorp LP, vol. 20(4), pages 866-891, December.
    31. Matias D. Cattaneo & Roc ́ıo Titiunik & Gonzalo Vazquez-Bare, 2016. "Inference in regression discontinuity designs under local randomization," Stata Journal, StataCorp LP, vol. 16(2), pages 331-367, June.
    32. Keele, Luke J. & Titiunik, Rocío, 2015. "Geographic Boundaries as Regression Discontinuities," Political Analysis, Cambridge University Press, vol. 23(1), pages 127-155, January.
    33. Fiorio, Carlo V. & Siciliani, Luigi, 2010. "Co-payments and the demand for pharmaceuticals: Evidence from Italy," Economic Modelling, Elsevier, vol. 27(4), pages 835-841, July.
    34. 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.
    35. Rainer Winkelmann, 2004. "Co‐payments for prescription drugs and the demand for doctor visits – Evidence from a natural experiment," Health Economics, John Wiley & Sons, Ltd., vol. 13(11), pages 1081-1089, November.
    36. Carnazza, Giovanni & Liberati, Paolo & Resce, Giuliano & Molinaro, Sabrina, 2021. "Smoking and income distribution: Inequalities in new and old products," Health Policy, Elsevier, vol. 125(2), pages 261-268.
    37. Sebastian Calonico & Matias D. Cattaneo & Max H. Farrell & Roc ́ıo Titiunik, 2017. "rdrobust: Software for regression-discontinuity designs," Stata Journal, StataCorp LP, vol. 17(2), pages 372-404, June.
    38. McCrary, Justin, 2008. "Manipulation of the running variable in the regression discontinuity design: A density test," Journal of Econometrics, Elsevier, vol. 142(2), pages 698-714, February.
    39. Papay, John P. & Willett, John B. & Murnane, Richard J., 2011. "Extending the regression-discontinuity approach to multiple assignment variables," Journal of Econometrics, Elsevier, vol. 161(2), pages 203-207, April.
    40. Luca Grassetti & Laura Rizzi, 2019. "The determinants of individual health care expenditures in the Italian region of Friuli Venezia Giulia: evidence from a hierarchical spatial model estimation," Empirical Economics, Springer, vol. 56(3), pages 987-1009, March.
    41. Burt S. Barnow & Matias D. Cattaneo & Rocío Titiunik & Gonzalo Vazquez‐Bare, 2017. "Comparing Inference Approaches for RD Designs: A Reexamination of the Effect of Head Start on Child Mortality," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 36(3), pages 643-681, June.
    42. Vincenzo Atella & Franco Peracchi & Domenico Depalo & Claudio Rossetti, 2006. "Drug compliance, co‐payment and health outcomes: evidence from a panel of Italian patients," Health Economics, John Wiley & Sons, Ltd., vol. 15(9), pages 875-892, September.
    43. Joshua D. Angrist & Miikka Rokkanen, 2015. "Wanna Get Away? Regression Discontinuity Estimation of Exam School Effects Away From the Cutoff," Journal of the American Statistical Association, Taylor & Francis Journals, vol. 110(512), pages 1331-1344, December.
    44. Lagravinese, Raffaele & Liberati, Paolo & Resce, Giuliano, 2019. "Exploring health outcomes by stochastic multicriteria acceptability analysis: An application to Italian regions," European Journal of Operational Research, Elsevier, vol. 274(3), pages 1168-1179.
    45. 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.
    46. Ya-Ling Lin & Wen-Yi Chen & Shwn-Huey Shieh, 2020. "Age Structural Transitions and Copayment Policy Effectiveness: Evidence from Taiwan’s National Health Insurance System," IJERPH, MDPI, vol. 17(12), pages 1-17, June.
    47. Frey, Anderson, 2019. "Cash transfers, clientelism, and political enfranchisement: Evidence from Brazil," Journal of Public Economics, Elsevier, vol. 176(C), pages 1-17.
    48. Abadie, Alberto & Diamond, Alexis & Hainmueller, Jens, 2010. "Synthetic Control Methods for Comparative Case Studies: Estimating the Effect of California’s Tobacco Control Program," Journal of the American Statistical Association, American Statistical Association, vol. 105(490), pages 493-505.
    49. Natalia Serna, 2021. "Cost sharing and the demand for health services in a regulated market," Health Economics, John Wiley & Sons, Ltd., vol. 30(6), pages 1259-1275, June.
    50. Angrist, Joshua D, 2001. "Estimations of Limited Dependent Variable Models with Dummy Endogenous Regressors: Simple Strategies for Empirical Practice: Reply," Journal of Business & Economic Statistics, American Statistical Association, vol. 19(1), pages 27-28, January.
    51. Gonzalo Vazquez-Bare & Matias Cattaneo & Rocio Titiunik, 2016. "rdlocrand: a Stata Package for Inference in Regression Discontinuity Designs under Local Randomizati," 2016 Stata Conference 25, Stata Users Group.
    52. Matias D. Cattaneo & Michael Jansson & Xinwei Ma, 2018. "Manipulation testing based on density discontinuity," Stata Journal, StataCorp LP, vol. 18(1), pages 234-261, March.
    53. Damon Clark & Paco Martorell, 2014. "The Signaling Value of a High School Diploma," Journal of Political Economy, University of Chicago Press, vol. 122(2), pages 282-318.
    54. Salvatore Greco & Alessio Ishizaka & Benedetto Matarazzo & Gianpiero Torrisi, 2018. "Stochastic multi-attribute acceptability analysis (SMAA): an application to the ranking of Italian regions," Regional Studies, Taylor & Francis Journals, vol. 52(4), pages 585-600, April.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Blaise Melly & Rafael Lalive, 2020. "Estimation, Inference, and Interpretation in the Regression Discontinuity Design," Diskussionsschriften dp2016, Universitaet Bern, Departement Volkswirtschaft.
    2. Mauricio Villamizar‐Villegas & Freddy A. Pinzon‐Puerto & Maria Alejandra Ruiz‐Sanchez, 2022. "A comprehensive history of regression discontinuity designs: An empirical survey of the last 60 years," Journal of Economic Surveys, Wiley Blackwell, vol. 36(4), pages 1130-1178, September.
    3. Jin-young Choi & Myoung-jae Lee, 2017. "Regression discontinuity: review with extensions," Statistical Papers, Springer, vol. 58(4), pages 1217-1246, December.
    4. Atı̇la Abdulkadı̇roğlu & Joshua D. Angrist & Yusuke Narita & Parag Pathak, 2022. "Breaking Ties: Regression Discontinuity Design Meets Market Design," Econometrica, Econometric Society, vol. 90(1), pages 117-151, January.
    5. Mellace, Giovanni & Ventura, Marco, 2019. "Intended and unintended effects of public incentives for innovation. Quasi-experimental evidence from Italy," Discussion Papers on Economics 9/2019, University of Southern Denmark, Department of Economics.
    6. Huber, Martin, 2019. "An introduction to flexible methods for policy evaluation," FSES Working Papers 504, Faculty of Economics and Social Sciences, University of Freiburg/Fribourg Switzerland.
    7. 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.
    8. Chu, Yu-Wei Luke & Cuffe, Harold E, 2020. "Do Struggling Students Benefit From Continued Student Loan Access? Evidence From University and Beyond," Working Paper Series 21067, Victoria University of Wellington, School of Economics and Finance.
    9. Crespo Cristian, 2020. "Beyond Manipulation: Administrative Sorting in Regression Discontinuity Designs," Journal of Causal Inference, De Gruyter, vol. 8(1), pages 164-181, January.
    10. Matias D. Cattaneo & Luke Keele & Rocío Titiunik & Gonzalo Vazquez-Bare, 2021. "Extrapolating Treatment Effects in Multi-Cutoff Regression Discontinuity Designs," Journal of the American Statistical Association, Taylor & Francis Journals, vol. 116(536), pages 1941-1952, October.
    11. Susan Athey & Guido W. Imbens, 2017. "The State of Applied Econometrics: Causality and Policy Evaluation," Journal of Economic Perspectives, American Economic Association, vol. 31(2), pages 3-32, Spring.
    12. Yoichi Arai & Yu‐Chin Hsu & Toru Kitagawa & Ismael Mourifié & Yuanyuan Wan, 2022. "Testing identifying assumptions in fuzzy regression discontinuity designs," Quantitative Economics, Econometric Society, vol. 13(1), pages 1-28, January.
    13. Crespo Cristian, 2020. "Beyond Manipulation: Administrative Sorting in Regression Discontinuity Designs," Journal of Causal Inference, De Gruyter, vol. 8(1), pages 164-181, January.
    14. Masayuki Sawada & Takuya Ishihara & Daisuke Kurisu & Yasumasa Matsuda, 2024. "Local-Polynomial Estimation for Multivariate Regression Discontinuity Designs," Papers 2402.08941, arXiv.org.
    15. Mellace, Giovanni & Ventura, Marco, 2023. "The short-run effects of public incentives for innovation in Italy," Economic Modelling, Elsevier, vol. 120(C).
    16. Matias D. Cattaneo & Rocío Titiunik, 2022. "Regression Discontinuity Designs," Annual Review of Economics, Annual Reviews, vol. 14(1), pages 821-851, August.
    17. Christopher Erwin, 2019. "Low-performing student responses to state merit scholarships," Working Papers 2019-02, Auckland University of Technology, Department of Economics.
    18. Giuseppe Francesco Gori & Patrizia Lattarulo & Marco Mariani, 2021. "The Expediting Effect of Monitoring on Infrastructural Works. A Regression-Discontinuity Approach with Multiple Assignment Variables," Papers 2102.09625, arXiv.org.
    19. Yiqi Liu & Yuan Qi, 2023. "Using Forests in Multivariate Regression Discontinuity Designs," Papers 2303.11721, arXiv.org, revised Jul 2024.
    20. Sebastian Calonico & Matias D Cattaneo & Max H Farrell, 2020. "Optimal bandwidth choice for robust bias-corrected inference in regression discontinuity designs," The Econometrics Journal, Royal Economic Society, vol. 23(2), pages 192-210.

    More about this item

    Keywords

    Multiple regression discontinuity (MRD); Healthcare; Co-payment; Demand effects; National Health System;
    All these keywords.

    JEL classification:

    • C31 - Mathematical and Quantitative Methods - - Multiple or Simultaneous Equation Models; Multiple Variables - - - Cross-Sectional Models; Spatial Models; Treatment Effect Models; Quantile Regressions; Social Interaction Models
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:empeco:v:67:y:2024:i:1:d:10.1007_s00181-023-02552-1. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.