Send to

Choose Destination
Appl Health Econ Health Policy. 2016 Oct;14(5):569-78. doi: 10.1007/s40258-016-0251-4.

Barrier to Access or Cost Share? Coinsurance and Dental-Care Utilization in Colombia.

Author information

Division of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, 55455, USA.
Facultad de Ciencias Administrativas y Económicas, Departamento de Economía, Universidad ICESI & PROESA, Calle 18 No. 122-135, Código postal 760031, Cali, Colombia.



Copayments, deductibles, and coinsurance, are elements of health-care systems to make prices salient for the insured. Individuals may respond differently to cost sharing, according to the type of care they seek; dental care, as a combination of both acute and elective care, is an ideal setting to study the effects of cost-sharing mechanisms on utilization.


To test how coinsurance affects dental-care utilization in a middle-income country context.


This study uses policy variations in the Colombian health-care system to analyze changes in dental-care utilization due to different levels of coinsurance. We used matching procedures to balance observed differences in pre-treatment variables between those who face coinsurance (non-policy holders, or beneficiaries) and those who don't (policyholders). We use zero-inflated negative binomial models for the count of visits and two-part models for total expenditures, and test for unobservable confounders with random-effect models and instrumental variables.


Individuals who face coinsurance are less likely to have any dental-care utilization, at a relatively small scale. Facing coinsurance does not correlate with changes in total expenditures. Falsification tests with dental-care visits exempt from coinsurance show no statistically distinguishable changes in utilization. Random-effect models and instrumental variable models show results similar to the main specification.


Cost-sharing policies in Colombia seem to be well designed because they don't represent an important barrier to dental-care access.

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center