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Effects of cost sharing on physician utilization under favourable conditions for supplier-induced demand

Author

Listed:
  • Carine Van De Voorde

    (Department of Economics, University of Leuven, Belgium)

  • Eddy Van Doorslaer

    (Department of Health Policy and Management, Erasmus University Rotterdam, Netherlands)

  • Erik Schokkaert

    (Department of Economics, University of Leuven, Belgium)

Abstract

The effects of cost sharing on the demand for ambulatory care in experimental circumstances are well understood since the Rand Health Insurance Experiment (HIE). However, in a non-experimental real-world context, supplier-induced demand of doctors might erode some of the significant negative out-of-pocket price elasticity identified in the HIE. Belgium is an interesting test case for this hypothesis because it has relatively high rates of patient cost sharing in its public health insurance system and a very high density of physicians, all remunerated fee-for-service. We have exploited the price variation generated by a substantial increase in patient co-payment rates in 1994 to estimate out-of-pocket price elasticities for three groups of users, and for three types of services using a fixed-effects model in levels and in differences. We obtain significant out-of-pocket price elasticities for the general population in the range from −0.39 to −0.28 for GP home visits, −0.16 to −0.12 for GP office visits and −0.10 for specialist visits. The estimates were generally lower and less significant for the groups of elderly and disabled. The differences we find in price responsiveness appear to be fairly robust and consistent with the HIE predictions. These results suggest that-at least in the short run-non-experimental utilization effects of cost sharing are very similar to the experimental evidence, even in a situation of favourable conditions for supplier-induced demand. Copyright © 2001 John Wiley & Sons, Ltd.

Suggested Citation

  • 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.
  • Handle: RePEc:wly:hlthec:v:10:y:2001:i:5:p:457-471
    DOI: 10.1002/hec.631
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    File URL: http://hdl.handle.net/10.1002/hec.631
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    References listed on IDEAS

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    Cited by:

    1. Erik Schokkaert & Carine Van de Voorde, 2005. "Health care reform in Belgium," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 25-39.
    2. Izabela Jelovac, 2015. "Physicians’ balance billing, supplemental insurance and access to health care," International Journal of Health Economics and Management, Springer, vol. 15(2), pages 269-280, June.
    3. Barros, Pedro Pita & Machado, Matilde P. & Sanz-de-Galdeano, Anna, 2008. "Moral hazard and the demand for health services: A matching estimator approach," Journal of Health Economics, Elsevier, vol. 27(4), pages 1006-1025, July.
    4. repec:eee:joecag:v:6:y:2015:i:c:p:24-43 is not listed on IDEAS
    5. Nicolas Ziebarth, 2014. "Assessing the effectiveness of health care cost containment measures: evidence from the market for rehabilitation care," International Journal of Health Economics and Management, Springer, vol. 14(1), pages 41-67, March.
    6. 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.
    7. Schokkaert, Erik & Van de Voorde, Carine, 2003. "Belgium: risk adjustment and financial responsibility in a centralised system," Health Policy, Elsevier, vol. 65(1), pages 5-19, July.
    8. Kwon, Hye-Young & Hong, Ji-Min & Godman, Brian & Yang, Bong-Min, 2013. "Price cuts and drug spending in South Korea: The case of antihyperlipidemic agents," Health Policy, Elsevier, vol. 112(3), pages 217-226.
    9. Ha Trong Nguyen & Luke B Connelly, 2017. "Cost-sharing in health insurance and its impact in a developing country: evidence from a quasi-natural experiment," Bankwest Curtin Economics Centre Working Paper series WP1702, Bankwest Curtin Economics Centre (BCEC), Curtin Business School.
    10. 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.
    11. Farbmacher, Helmut, 2009. "Copayments for doctor visits in Germany and the probability of visiting a physician - Evidence from a natural experiment," Discussion Papers in Economics 10951, University of Munich, Department of Economics.
    12. Paolo Buonanno & Matteo M. Galizzi, 2009. "Advocatus, et non latro? Testing the supplier-induced demand hypothesis for Italian courts of justice," Working Papers 0914, University of Brescia, Department of Economics.
    13. Shengelia, Bakhuti & Tandon, Ajay & Adams, Orvill B. & Murray, Christopher J.L., 2005. "Access, utilization, quality, and effective coverage: An integrated conceptual framework and measurement strategy," Social Science & Medicine, Elsevier, vol. 61(1), pages 97-109, July.
    14. Buonanno Paolo & Galizzi Matteo M., 2014. "Advocatus, et non Latro? Testing the Excess of Litigation in the Italian Courts of Justice," Review of Law & Economics, De Gruyter, vol. 10(3), pages 1-38, November.
    15. 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.
    16. David Madden & Anne Nolan & Brian Nolan, 2005. "GP reimbursement and visiting behaviour in Ireland," Health Economics, John Wiley & Sons, Ltd., vol. 14(10), pages 1047-1060.
    17. Mas, Nuria & Cirera, Laia & Viñolas, Guillem, 2011. "Los sistemas de copago en Europa, Estados Unidos y Canadá: Implicaciones para el caso español," IESE Research Papers D/939, IESE Business School.
    18. 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.
    19. Perronnin, Marc, 2013. "Effet de l'assurance complémentaire santé sur les consommations médicales, entre risque moral et amélioration de l'accès aux soins," Economics Thesis from University Paris Dauphine, Paris Dauphine University, number 123456789/13659 edited by Wittwer, Jérôme.

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