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J Health Econ. 2018 May;59:109-124. doi: 10.1016/j.jhealeco.2018.03.006. Epub 2018 Apr 16.

Patient cost-sharing, socioeconomic status, and children's health care utilization.

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Department of Economics and Business Economics, Aarhus University, DK-8210 Aarhus, Denmark; Centre for Economic Demography, Lund University, SE-22007 Lund, Sweden. Electronic address:
Department of Economics and Business Economics, Aarhus University, DK-8210 Aarhus, Denmark. Electronic address:


This paper estimates the effect of cost-sharing on the demand for children's and adolescents' use of medical care. We use a large population-wide registry dataset including detailed information on contacts with the health care system as well as family income. Two different estimation strategies are used: regression discontinuity design exploiting age thresholds above which fees are charged, and difference-in-differences models exploiting policy changes. We also estimate combined regression discontinuity difference-in-differences models that take into account discontinuities around age thresholds caused by factors other than cost-sharing. We find that when care is free of charge, individuals increase their number of doctor visits by 5-10%. Effects are similar in middle childhood and adolescence, and are driven by those from low-income families. The differences across income groups cannot be explained by other factors that correlate with income, such as maternal education.


Children; Cost-sharing; Difference-in-differences; Health care utilization; Income-health gradient; Regression discontinuity

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