The effects of copayment in primary health care: evidence from a natural experiment

Abstract

Objective: Evaluate the effects of the 'euro per prescription' on primary health care services (number of doctor visits), through a retrospective cohort study of health care users in Catalonia (Spain). This policy, implemented in Catalonia on 23 June 2012, only lasted six months. This policy was introduced to improve budgetary imbalances in Spain and boost the regional and national governments' budgets. Methods:We used a retrospective cohort, composed of individuals who had had contact with primary healthcare services between January 1, 2005 and December 31, 2012. The econometric specification followed is a hurdle model. Results:Our results show that from October 2012 onwards there was a decrease in the average number of overall visits, particularly for individuals aged 65 years or more. However, this decline cannot be entirely attributed to the introduction of the euro per prescription policy as in October of that same year the Spanish government introduced its pharmaceutical copayment for pensioners. Conclusions:The policies appraised in this paper reveal a clear deterrent effect among vulnerable individuals such as those with the highest probability of being unemployed and/or those individuals with chronic conditions.

Degree of regional variation and effects of health insurance-related factors on the utilization of 24 diverse healthcare services - a cross-sectional study

“…However, higher out-of-pocket costs may also make people more reluctant to use services, constituting a financial barrier [32]. While non-insurance practically does not occur in Switzerland, foregoing healthcare utilization due to out-of-pocket costs has been previously documented [33][34][35]. People having supplementary insurance in addition to mandatory insurance may be wealthier, and more health-conscious and Fig.…”

Influence of Pharmaceutical Copayment on Emergency Hospital Admissions: A 1978–2018 Time Series Analysis in Spain

“…Different studies have evaluated the influence of pharmaceutical copayments on different aspects of health [7][8][9][10][11][12][13][14][15][16][17][18], such as adherence to therapy [7,9,10,16], smoking cessation [8], reduction in the use of drugs [11,12,15,17], physician consultations [13,14,18] and hospital admissions [14,16,18]. Regarding hospital admissions [14,16,18], two studies have focused on specific patients [16,18], assessing the impact of either increasing or decreasing pharmaceutical costs during one year.…”