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

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. © 2016, Springer International Publishing Switzerland.

• Autores: Higuera, Lucas; Prada Ríos, Sergio Iván
• Tipo de recurso: Article of investigation
• Fecha de publicación: 2016
• Institución: Universidad ICESI
• Repositorio: Repositorio ICESI
• Idioma: eng
• OAI Identifier: oai:repository.icesi.edu.co:10906/81733
• Acceso en línea: https://www.scopus.com/inward/record.uri?eid=2-s2.0-84975486656&doi=10.1007%2fs40258-016-0251-4&partnerID=40&md5=3f8dce1292f2ff8faa8b798c797097b7; http://hdl.handle.net/10906/81733; http://dx.doi.org/10.1007/s40258-016-0251-4
• Palabra clave: Tratamiento dental; Sistema de salud - Colombia; Economía; Economics
• Rights: openAccess
• License: https://creativecommons.org/licenses/by-nc-nd/4.0/