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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

1
Division of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, 55455, USA. higue003@umn.edu.
2
Facultad de Ciencias Administrativas y Económicas, Departamento de Economía, Universidad ICESI & PROESA, Calle 18 No. 122-135, Código postal 760031, Cali, Colombia.

Abstract

BACKGROUND:

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.

OBJECTIVE:

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

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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

PMID:
27333795
DOI:
10.1007/s40258-016-0251-4
[Indexed for MEDLINE]

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