Danish Centre for Health Economics (DaCHE), Department of Public Health, University of Southern Denmark, Odense, Denmark.
Health Econ. 2022 Oct;31 Suppl 2(Suppl 2):92-114. doi: 10.1002/hec.4582. Epub 2022 Aug 13.
The literature around co-payment shows evidence of increasing consumption following reduced co-payment. We apply difference-in-difference methods to assess the effect of abolishing the co-payment on psychologist treatment of anxiety and depression in 18 to 21-year olds. We apply nationwide individual level data with individuals close to this age interval as control group. The population amounts to approximately 1.2 million individuals and a total of 51 million patient months of observations. We show that after removing co-payment, the use of psychologist treatment almost doubles. We find that this increase involves moderately positive spill over effects on outpatient psychiatric care and on prescriptions of antidepressants. In the heterogeneity analysis we find evidence of higher effects on adolescents from families with lower income, indicating that reduced co-payments may increase equality in access. We also see that effects are higher for individuals listed with general practitioners (GPs) with a reluctant referral style; indicating that these GPs' behavior is affected by patient co-payment rates. Interestingly, we find evidence of significant reductions in suicide attempts - primarily among high-income women and low-income men. This indicates that better access to mental health care for adolescents may have a positive impact on their mental health and well-being.
关于共同支付的文献表明，共同支付减少后，消费有增加的迹象。我们应用双重差分法来评估取消共同支付对 18 至 21 岁人群中焦虑和抑郁的心理治疗的影响。我们使用全国范围内的个人层面数据，以接近这个年龄区间的个人作为对照组。该人群数量约为 120 万人，观察期总共有 5100 万患者月。我们发现，取消共同支付后，心理治疗的使用几乎增加了一倍。我们发现这种增加涉及对门诊精神科护理和抗抑郁药处方的适度积极溢出效应。在异质性分析中，我们发现证据表明，收入较低的家庭的青少年受到的影响更大，这表明降低共同支付可能会增加获得服务的平等性。我们还发现，对于那些以 GP 为主要介绍人的个体（GP）来说，效果更高，这些 GP 的转诊态度较为勉强；这表明这些 GP 的行为受到患者共同支付率的影响。有趣的是，我们发现自杀企图的显著减少的证据 - 主要是在高收入女性和低收入男性中。这表明，青少年获得心理健康服务的机会增加可能对他们的心理健康和幸福感产生积极影响。
