Publication detail

The Abolition of User Charges and the Demand for Ambulatory Visits: Evidence from the Czech Republic

Author(s): PhDr. Jana Votápková Ph.D., Pavlína Žílová
Type: Articles in journals with impact factor
Year: 2016
Number: 6
Published in: Health Economics Review
Publishing place:
Keywords: Co-payments,  Outpatient care,  Czech Republic,  Natural experiment,  Zero-inflated negative binomial model (ZINB),  Multinomial logit (MNL) model
JEL codes:
Suggested Citation: Votapkova, J. & Zilova, P. Health Econ Rev (2015) 6: 29. doi:10.1186/s13561-016-0105-7
Grants: GAUK 910 915 Analysis of Czech Hospitals: Cost Efficiency & Impact of User Charges on the Amount of Inpatient Care Provided
Abstract: The paper estimates the effect of the abolition of user charges for outpatient care (30 CZK/1.2 EUR) in 2009 on the demand for ambulatory doctor visits in the Czech Republic. The reform applied only to children, which enabled us to take the difference-in-differences (DiD) approach. Children constitute a treatment group, whereas adults serve as a control group. Besides the treatment effect, we control also for a number of personal characteristics using a micro-level data (European Union Statistics on Income and Living Conditions (EU-SILC)). We estimate two models: Multinomial logit (MNL) and Zero-inflated negative binomial (ZINB). The effect of the abolition of user charges on the number of doctor visits proved insignificant suggesting that either the demand for this type of care is indeed inelastic, user charges were set too low or the people have not changed their behavior yet. On the contrary, we found that personal income, the number of household members and sex significantly influence the number of visits to the doctor. A number of robustness checks using restricted samples confirms the results.


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