Haaga Tapio, Böckerman Petri, Kortelainen Mika, Tukiainen Janne
Turku School of Economics, University of Turku, FI-20014, Finland; Finnish Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland.
Jyväskylä University School of Business and Economics, University of Jyväskylä, P.O. Box 35, FI-40014, Finland; Labour Institute for Economic Research LABORE, Arkadiankatu 7, FI-00100 Helsinki, Finland.
J Health Econ. 2024 Mar;94:102866. doi: 10.1016/j.jhealeco.2024.102866. Epub 2024 Feb 28.
Nurses are increasingly providing primary care, yet the literature on cost-sharing has paid little attention to nurse visits. We employ a staggered difference-in-differences design to examine the effects of adopting a 10-euro copayment for nurse visits on the use of public primary care among Finnish adults. We find that the copayment reduced nurse visits by 9%-10% during a one-year follow-up. There is heterogeneity by income in absolute terms, but not in relative terms. The spillover effects on general practitioner (GP) use are negative but small, with varying statistical significance. We also analyze the subsequent nationwide abolition of the copayment. However, we refrain from drawing causal conclusions from this due to the lack of credibility in the parallel trends assumption. Overall, our analysis suggests that moderate copayments can create a greater barrier to access for low-income individuals. We also provide an example of using a pre-analysis plan for retrospective observational data.
护士越来越多地提供初级保健服务，但关于费用分担的文献很少关注护士问诊。我们采用交错差分设计，研究对芬兰成年人的护士问诊收取10欧元自付费用对公共初级保健服务使用情况的影响。我们发现，在一年的随访期内，自付费用使护士问诊次数减少了9%-10%。绝对收入水平存在异质性，但相对收入水平不存在异质性。对全科医生（GP）服务使用的溢出效应为负但很小，且统计显著性各异。我们还分析了随后在全国范围内取消自付费用的情况。然而，由于平行趋势假设缺乏可信度，我们没有从中得出因果结论。总体而言，我们的分析表明，适度的自付费用会给低收入人群造成更大的就医障碍。我们还提供了一个对回顾性观察数据使用预分析计划的示例。
