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The impact of copayments on mental healthcare utilization: a natural experiment

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  • Timo R. Lambregts

    (Erasmus University Rotterdam)

  • René C. J. A. Vliet

    (Erasmus University Rotterdam)

Abstract

Empirical evidence suggests that people are fairly sensitive to cost sharing arrangements in ambulatory mental healthcare. However, pure cost sharing effects are typically hard to measure due to the presence of adverse selection effects. In this paper, we examine the impact of cost sharing on mental healthcare utilization in the context of mandatory health insurance where adverse selection is absent. Using a large proprietary dataset of a Dutch private health insurer, we examine to what extent a new copayment scheme for adult mental healthcare changed healthcare utilization. We exploit the fact that non-adults are exempted from copayments. First, we compare changes in utilization among adults and non-adults using t tests and a difference-in-difference analysis. Second, we highlight differential changes in mental healthcare utilization by treatment (duration and type of mental illness) and individual characteristics (gender and socioeconomic status). Third, we evaluate to what extent anticipatory behavior occurred pending the introduction and subsequent repeal of the new copayment scheme. Our results show a strong and significant (p

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  • Timo R. Lambregts & René C. J. A. Vliet, 2018. "The impact of copayments on mental healthcare utilization: a natural experiment," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(6), pages 775-784, July.
    • Handle: RePEc:spr:eujhec:v:19:y:2018:i:6:d:10.1007_s10198-017-0921-7
    DOI: 10.1007/s10198-017-0921-7
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    Citations

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    Cited by:

    1. Berger, Michael & Six, Eva & Czypionka, Thomas, 2024. "Policy implications of heterogeneous demand reactions to changes in cost-sharing: patient-level evidence from Austria," LSE Research Online Documents on Economics 121162, London School of Economics and Political Science, LSE Library.
    2. 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.
    3. Michael Berger & Thomas Czypionka, 2021. "Regional medical practice variation in high-cost healthcare services," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(6), pages 917-929, August.
    4. Lopes, Francisca Vargas & Riumallo Herl, Carlos J. & Mackenbach, Johan P. & Van Ourti, Tom, 2022. "Patient cost-sharing, mental health care and inequalities: A population-based natural experiment at the transition to adulthood," Social Science & Medicine, Elsevier, vol. 296(C).
    5. Rudy Douven & Minke Remmerswaal & Tobias Vervliet, 2021. "Payment schemes and treatment responses after a demand shock in mental health care," Health Economics, John Wiley & Sons, Ltd., vol. 30(12), pages 2956-2973, December.
    6. Berger, Michael & Six, Eva & Czypionka, Thomas, 2024. "Policy implications of heterogeneous demand reactions to changes in cost-sharing: Patient-level evidence from Austria," Social Science & Medicine, Elsevier, vol. 340(C).
    7. Rudy Douven & Minke Remmerswaal & Tobias Vervliet, 2019. "Treatment responses of mental health care providers after a demand shock," CPB Discussion Paper 404.rdf, CPB Netherlands Bureau for Economic Policy Analysis.
    8. Berger, Michael & Czypionka, Thomas, 2021. "Regional medical practice variation in high-cost healthcare services: evidence from diagnostic imaging in Austria," LSE Research Online Documents on Economics 112952, London School of Economics and Political Science, LSE Library.
    9. Marie Kruse & Kim Rose Olsen & Christian Volmar Skovsgaard, 2022. "Co‐payment and adolescents' use of psychologist treatment: Spill over effects on mental health care and on suicide attempts," Health Economics, John Wiley & Sons, Ltd., vol. 31(S2), pages 92-114, October.
    10. Rudy Douven & Minke Remmerswaal & Tobias Vervliet, 2019. "Treatment responses of mental health care providers after a demand shock," CPB Discussion Paper 404, CPB Netherlands Bureau for Economic Policy Analysis.
    11. Albertini, Mattia & Bakx, Pieter & Mazzonna, Fabrizio, 2025. "Health and Labor Market Consequences of Low-Value Care: The Role of Practice Style," IZA Discussion Papers 17771, Institute of Labor Economics (IZA).
    12. Velisha A. Perumal-Pillay & Shiraz R. Alli & Fatima Suleman, 2018. "The Perceptions of Patient Copayment on the Reported Adherence to Prescription Medication," Global Journal of Health Science, Canadian Center of Science and Education, vol. 10(11), pages 105-105, November.

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    JEL classification:

    • D12 - Microeconomics - - Household Behavior - - - Consumer Economics: Empirical Analysis
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

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