Does the framing of patient cost-sharing incentives matter? The effects of deductibles vs. no-claim refunds
| Autor: | Arthur P. Hayen, Martin Salm, Tobias J. Klein |
|---|---|
| Přispěvatelé: | Econometrics and Operations Research, Tilburg Law and Economic Center (TILEC), Research Group: Econometrics |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
dynamic panels
incentives contracts -- altruism -- dynamic panels -- healthcare Quality care Deductible loss aversion Health insurance Framing (construction) Health care Deductibles and Coinsurance ddc:330 D91 Humans ddc:610 Fakultät für Wirtschaftswissenschaften Cost Sharing Patient cost-sharing health care economics and organizations H51 Motivation framing Insurance Health Public economics business.industry Health Policy I13 Public Health Environmental and Occupational Health healthcare Limiting Incentive altruism patient cost-sharing health insurance incentives contracts Cost sharing Framing business Delivery of Health Care |
| Zdroj: | Journal of Health Economics, 80:102520. Elsevier Science BV |
| ISSN: | 0167-6296 |
| Popis: | Understanding how health care utilization responds to cost-sharing incentives is of central importance for providing high quality care and limiting the growth of costs. While there is compelling evidence that patients react to financial incentives, it is less well understood how and why specific aspects of the design of contracts shape the size of this reaction. In this paper, we focus on the question whether the framing of cost-sharing incentives has an effect on health care utilization. To study this, we make use of a policy change that occurred in the Netherlands. Until 2007, patients received a no-claim refund if they consumed little or no health care; from 2008 onward there was a deductible instead. This means that very similar economic incentives were first framed in terms of smaller gains and later as losses. We use claims-level data for a broad sample from the Dutch population to estimate whether the reaction to economic incentives was affected by this. Our empirical approach is to exploit within-year variation using an instrumental variables approach while controlling for differences across years. Our central finding is that patients react to incentives much more strongly when they are framed in terms of losses. Simulations based on our estimates show that the effect on yearly spending is 8.6 percent. This suggests that discussions on the optimal design of cost-sharing incentives should not only involve coinsurance rates and cost-sharing limits, but also how these are presented to patients. CINCH working paper series, vol. 2019, no. 4 |
| Databáze: | OpenAIRE |
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