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The abolition of user charges and the demand for ambulatory visits: evidence from the Czech Republic

Author

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  • Jana Votapkova

    (Charles University)

  • Pavlina Zilova

    (Charles University)

Abstract

This paper estimates the effect of the abolition of user charges for children’s outpatient care (30 CZK/1.2 EUR) in 2009 on the demand for ambulatory doctor visits in the Czech Republic. Because the reform applied only to children, we can employ the difference-in-differences approach, where children constitute a treatment group and adults serve as a control group. The dataset covers 1841 observations. Aside from the treatment effect, we control for a number of personal characteristics using micro-level data (European Union Statistics on Income and Living Conditions). Using the zero-inflated negative binomial model, we found no significant effect from the abolition of user charges on doctor visits, suggesting either that user charges are ineffective in the Czech environment or that their value was set too low. On the contrary, personal income, the number of household members and gender have a significant effect. A number of robustness checks using restricted samples confirm the results.

Suggested Citation

  • Jana Votapkova & Pavlina Zilova, 2016. "The abolition of user charges and the demand for ambulatory visits: evidence from the Czech Republic," Health Economics Review, Springer, vol. 6(1), pages 1-11, December.
    • Handle: RePEc:spr:hecrev:v:6:y:2016:i:1:d:10.1186_s13561-016-0105-7
    DOI: 10.1186/s13561-016-0105-7
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    References listed on IDEAS

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    1. Chiappori, Pierre-Andre & Durand, Franck & Geoffard, Pierre-Yves, 1998. "Moral hazard and the demand for physician services: First lessons from a French natural experiment," European Economic Review, Elsevier, vol. 42(3-5), pages 499-511, May.
    2. Schreyögg, Jonas & Grabka, Markus M., 2010. "Copayments for Ambulatory Care in Germany: A Natural Experiment Using a Difference-in-Difference Approach," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 11(3), pages 331-341.
    3. Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-277, June.
    4. 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.
    5. van Doorslaer, Eddy & Wagstaff, Adam & van der Burg, Hattem & Christiansen, Terkel & De Graeve, Diana & Duchesne, Inge & Gerdtham, Ulf-G & Gerfin, Michael & Geurts, Jose & Gross, Lorna, 2000. "Equity in the delivery of health care in Europe and the US," Journal of Health Economics, Elsevier, vol. 19(5), pages 553-583, September.
    6. van Wijk, Cecile M.T.Gijsbers & Kolk, Annemarie M. & van Den Bosch, Wil J.H.M. & Van Den Hoogen, Henk J.M., 1992. "Male and female morbidity in general practice: The nature of sex differences," Social Science & Medicine, Elsevier, vol. 35(5), pages 665-678, September.
    7. Augurzky, Boris & Bauer, Thomas K. & Schaffner, Sandra, 2006. "Copayments in the German Health System: Does It Work?," IZA Discussion Papers 2290, Institute of Labor Economics (IZA).
    8. Jan Zápal, 2010. "Doctor-Visit Co-Payment Exemption for Children: First Look at the Data," Czech Journal of Economics and Finance (Finance a uver), Charles University Prague, Faculty of Social Sciences, vol. 60(1), pages 58-72, February.
    9. Kim, Jiyun & Ko, Sukyoung & Yang, Bongmin, 2005. "The effects of patient cost sharing on ambulatory utilization in South Korea," Health Policy, Elsevier, vol. 72(3), pages 293-300, June.
    10. Kan, Mari & Suzuki, Wataru, 2010. "Effects of cost sharing on the demand for physician services in Japan: Evidence from a natural experiment," Japan and the World Economy, Elsevier, vol. 22(1), pages 1-12, January.
    11. Lundberg, Lena & Johannesson, Magnus & Isacson, Dag G. L. & Borgquist, Lars, 1998. "Effects of user charges on the use of prescription medicines in different socio-economic groups," Health Policy, Elsevier, vol. 44(2), pages 123-134, May.
    12. 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.
    13. J. Scott Long & Jeremy Freese, 2006. "Regression Models for Categorical Dependent Variables using Stata, 2nd Edition," Stata Press books, StataCorp LP, edition 2, number long2, March.
    14. Baji, Petra & Pavlova, Milena & Gulácsi, LászlÓ & Groot, Wim, 2011. "User fees for public health care services in Hungary: Expectations, experience, and acceptability from the perspectives of different stakeholders," Health Policy, Elsevier, vol. 102(2), pages 255-262.
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