Effect of a cost-sharing variation on the utilization of GES insurance and private healthcare services

Abstract

Since 2006, the cost-sharing faced by the public insurer beneficiaries aged 60 years and over had decreased to zero for all “Garantias Explicitas en Salud” (Explicit Health Guarantees, GES) care and non-GES services provided within the public healthcare system. In this study, we analyze the effect of the cost-sharing variation on the utilization of public and private healthcare services utilization. Using the 2016-2019 FONASA beneficiary’s database, the first-time utilization (aka activation) of the GES insurance database, and the private medical claim registry, through the implementation of a regression discontinuity design, we estimated the treatment effect of this policy. We found that the decrease in cost-sharing translates into a 3- percentage point increase in the GES insurance activation. If we restrict our analysis to the activation of chronic GES insurance, we found an increase of 5 percentage Regarding private healthcare services, our findings suggest that utilization of healthcare services through the MLE scheme is, for the most part, not responsive (by means of an increase in opportunity cost) to variations in cost-sharing for public healthcare services, except for hospitalization services, where we estimate a decrease of 11 percentage points in their utilization, although this estimate is significant only at a 10% of significance. Additionally, we found that treatment is heterogeneously distributed across different subgroups of the population.