Health Metrics, Sahlgrenska Academy at University of Gothenburg, PO Box 463, 405 30, Gothenburg, Sweden.
Department of Economics, Karlstad University, Universitetsgatan 2, 651 88, Karlstad, Sweden.
Eur J Health Econ. 2019 Nov;20(8):1271-1280. doi: 10.1007/s10198-019-01095-6. Epub 2019 Aug 10.
We estimate the price sensitivity in health care among adolescents and young adults, and assess how it varies across income groups and gender, using a regression discontinuity design. We use the age differential cost-sharing in Swedish primary care as our identification strategy. At the 20th birthday, the copayment increases from €0 to approx. €10 per primary care physician visit and close to this threshold the copayment faced by each person is distributed almost as good as if randomized. The analysis is performed using high-quality health care and economic register data of 73,000 individuals aged 18-22. Our results show that the copayment decreases the average number of visits by 7%. Among women visits are reduced by 9%, for low-income individuals by 11%, and for low-income women by 14%. In conclusion, modest copayments have significant utilization effects, and even in a policy context with relatively low income inequalities, the effect is substantially larger in low-income groups and among women.
我们使用回归不连续设计来估计青少年和年轻人的医疗保健价格敏感度，并评估其在收入群体和性别之间的差异。我们使用瑞典初级保健中年龄差异共付制作为我们的识别策略。在 20 岁生日时，自付额从€0 增加到每次看初级保健医生约€10，在接近这个门槛时，每个人面临的自付额分配几乎与随机分配一样好。分析使用了 73000 名 18-22 岁的高质量医疗保健和经济登记数据。我们的研究结果表明，自付额使平均就诊次数减少了 7%。女性就诊次数减少了 9%，低收入人群减少了 11%，低收入女性减少了 14%。总之，适度的自付额会产生显著的使用效果，即使在收入不平等相对较低的政策环境下，低收入群体和女性的效果也会大得多。
