EuHEA Seminar Series spring 2021
EuHEA seminar series, every Thursday at 14:00.
Presenting March 4th
Michael Berger: Devil in the details: How urgency and costs influence the effects of cost-sharing on healthcare service consumption patterns
Chair: Izabela Jelovac
Discussant: Mikael SvenssonRegister here
The seminars are for free.
Objectives: Decision makers frequently use cost-sharing to alleviate pressure on public healthcare budgets. Apart from generating revenue directly, cost-sharing is a means to influence and steer the behaviour of patients to control demand for healthcare services and thereby address moral hazard. The effect of cost-sharing on demand for healthcare services has been heavily studied in the literature, but researchers often apply a macro-perspective on these issues, opening the door for the fallacy of assuming uniform demand reactions across a spectrum of different healthcare services. The aim of this article is to estimate price elasticities of a variety of healthcare services to highlight how they depend on urgency and price.
Methods: We utilise a dataset of pseudonymised longitudinal patient-level data on healthcare service consumption between Q2-2015 and Q2-2017 of three different sickness funds in Austria covering 1,035,177 patients. We estimate the price elasticity of a set of 11 healthcare services differing in urgency and price. We combine matching via entropy balancing and difference-in-differences estimation in a two-stage study design following a reduction in the co-insurance rate by one of the sickness funds from 20% to 10% in Q2-2016. We further test the robustness of our result using different frequencies on the dependent variable and placebo regression.
Results: The reduction of the co-insurance rate led to a small increase in demand for routine ECGs (+1.5%) and a negligible increase for electromyography (+0.1%) over the whole post-treatment period. Only the effect for routine ECG is statistically significant and robust to our sensitivity analyses. For the nine other healthcare services, pre-trends fail the necessary conditions for a difference-in-differences framework.
Discussion: Our results show that price elasticities of different healthcare services depend on their urgency and costs and cast a new light on previous empirical evidence on price elasticity of healthcare services derived without differentiation between services. Routine ECGs and electromyography are two comparatively expensive healthcare services in the outpatient sector. But whereas routine ECGs are often performed during a health check-up and can easily be postponed by patients, electromyography is more urgent and patients do not have discretion over the timing of the healthcare service consumption. For healthcare services that are urgent, low cost or both, we do not find evidence that a change in co-insurance rate affects demand. A limitation to our study is that some of the healthcare services are not frequently consumed and may be prone to distortions by regional or seasonal fluctuations which may cause deviations in pre-trends. In combination with a small effect size, this likely contributes to the comparatively low statistical significance of the findings.
More about Michael Berger
Women in Distress: Mental Health and the COVID19 Pandemic
Emilia Barili, University of Genoa
Factors associated with lockdown opinions during the second national lockdown in France, attitudes toward the end-of year celebrations and the use of digital contact-tracing ‘TousAntiCovid’
Pauline Kergall, University of Montpellier
An App Call a Day Keeps the Patient Away? On the Substitution of Online and In-Person Doctor Consultations
Lina Maria Ellegård, University of Lund
Devil in the details: How urgency and costs influence the effects of cost-sharing on healthcare service consumption patterns
Michael Berger, Medical University of Vienna
Quality provision in hospital markets with demand inertia: The role of patient expectations
Luís Sá, University of Minho
Do the guidelines apply to me? - Patient information and physician agency in prenatal diagnostics
Nis Lydiksen, University of Southern Denmark
Do subsidized nursing homes and home care teams reduce hospital bed-blocking? Evidence from Portugal
Ana Moura, Tilburg University
How Distorted Food Prices Discourage a Healthy Diet
Thijs van Rens, University of Warwick
Lifetime Healthcare Expenditures Across Socio-Economic Groups: Wiping Out the Gradient
Alexander Overdal Kjærsgaard Marin, University of Aarhus
In response to the cancellation of the in-person EuHEA 2020 conference in Oslo, the EuHEA Seminar Series was launched with the joint efforts of Oslo’s scientific committee, EuHEA and countries’ representatives. Invitation of seminar speakers was initially guided by review scores for papers submitted to the EuHEA 2020 conference in Oslo. The web-based seminars provided a venue for bringing together the Health Economics community for sharing and discussing research. Following the success of the virtual seminar series in fall 2020, seminars will continue in 2021.