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The Impact of An Increase in User Costs on the Demand For Emergency Services: The Case of Portuguese Hospitals

Author

Listed:
  • Pedro Ramos

    () (Faculdade de Economia, Universidade do Porto)

  • Álvaro Almeida

    () (CEF.UP and Faculdade de Economia, Universidade do Porto)

Abstract

Evidence on the impact of user costs on healthcare demand in “universal” public National Health Service (NHS) systems is scarce. The changes in copayments and in the regulation of the provision of free patient transportation, introduced in early 2012 in Portugal, provide a natural experiment to evaluate that impact. However, those changes in user costs were accompanied with changes in the criteria that determine which patients are exempt from copayments, implying that changes to the underlying populations made simple comparisons of user rates meaningless. The aim of this paper is to evaluate the impact of increases in direct and indirect user costs on the demand for emergency services (ES), in the context of changes to the underlying populations of exempt and non-exempt patients. Our contributions are twofold: we develop a new methodology for analyzing ES demand changes following user cost increases when the underlying population is not constant, and we measure the relative impact of copayments and distance costs on ES demand, in NHS-countries, with “almost free” access to healthcare. Our results show that the increase in copayments did not have a significant effect in moderating ES demand by paying users. On the other hand, we find a significant effect of the change in transport regulation in the demand for ES, especially in the more general polyvalent ES and for older patients. Thus, our results support the conclusion that indirect costs may be more important than direct costs in determining healthcare demand in NHS-countries where copayments are small and wide exemption schemes are in place, especially for older patients.

Suggested Citation

  • Pedro Ramos & Álvaro Almeida, 2014. "The Impact of An Increase in User Costs on the Demand For Emergency Services: The Case of Portuguese Hospitals," FEP Working Papers 531, Universidade do Porto, Faculdade de Economia do Porto.
  • Handle: RePEc:por:fepwps:531
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    File URL: http://www.fep.up.pt/investigacao/workingpapers/wp531.pdf
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    References listed on IDEAS

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    More about this item

    Keywords

    Copayments; Indirect costs; healthcare demand;

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

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