Priced Out: Do Adolescents from Low-Income Families Respond More to Cost-Sharing in Primary Care?

Tapio Haaga; Petri Böckerman; Mika Kortelainen; Janne Tukiainen

doi:10.1515/bejeap-2024-0229

Abstract

We examine the heterogeneous effects of 14–21 euro copayments on primary care general practitioners (GPs) visits in Finland. Our study focuses on a triage-based appointment system in public primary care. Using an age-based regression discontinuity (RD) design and leveraging variation across Finnish municipalities in whether the copayment is charged, we analyze the effects at the 18th birthday, when previously exempted adolescents become subject to copayments. Using nationwide administrative data from 2011 to 2019, we find that GP visits decrease in the copayment municipalities by 4–5 %. The reductions are largest for the bottom 20 % of the equivalized family disposable income distribution: their GP use decreases by 0.08–0.10 annualized visits (7–10 %). Unexpectedly, the effects are also larger than average (albeit rather temporary) for the top 50 %, showing reductions of 6–8 %. Compared to earlier studies focusing on moderate copayments and different populations, our effect estimates are smaller, and the heterogeneity by income level is weaker.

Keywords: cost-sharing; out-of-pocket costs; healthcare use; primary care; regression discontinuity; difference-in-discontinuities

JEL Classification: I18; I14; I13; H42; I11

Corresponding author: Janne Tukiainen, University of Turku, Turku, Finland, E-mail: janne.tukiainen@utu.fi

Funding source: Finnish Ministry of Social Affairs and Health

Award Identifier / Grant number: N.A.

Funding source: Yrjö Jahnssonin Säätiö

Award Identifier / Grant number: 20197209

Acknowledgments

We thank Mikko Peltola, Heikki Kauppi, and THL for support, and Gustav Kjelsson, Matti Sarvimäki, Liisa T. Laine, Tuomas Markkula, Mikko Nurminen, Joonas Ollonqvist, Jukka Pirttilä, Henri Salokangas, Tanja Saxell, Lauri Sääksvuori, and Jussi Tervola for comments and suggestions. We thank all seminar participants who have provided comments to this study and our other related projects. This work is supported by Yrjö Jahnsson Foundation (research grant No. 20197209) and by the Finnish Ministry of Social Affairs and Health. Replication codes: https://github.com/tapiohaa/ASMA1. Earlier versions: https://osf.io/vmuzf/.

Author contributions: Haaga: Conceptualization, Formal analysis, Writing – Original Draft, Writing – Review & Editing. Böckerman: Conceptualization, Writing – Review & Editing, Supervision. Kortelainen: Conceptualization, Writing – Review & Editing, Supervision. Tukiainen: Conceptualization, Writing – Review & Editing, Supervision.
Research funding: Finnish Ministry of Social Affairs and Health and Yrjö Jahnssonin Säätiö (20197209).

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/bejeap-2024-0229).

Received: 2024-07-08

Accepted: 2024-12-09

Published Online: 2025-01-20

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