Patient cost-sharing, mental health care and inequalities: A population-based natural experiment at the transition to adulthood

Francisca Vargas Lopes*, Carlos J. Riumallo Herl, Johan P. Mackenbach, Tom Van Ourti

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

7 Citations (Scopus)
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Abstract

Background: Patient cost-sharing has been increasing around the world, despite the evidence that it reduces both unnecessary and necessary health care utilisation. Financial barriers could compound to poor transitional care into adulthood, when forgoing mental health treatment may have long-term consequences on health and development. We evaluate the impact of increasing deductibles on mental health care use by young adults, and the heterogeneous effects for vulnerable groups. Methods: We use individual administrative records for 1,541,210 individuals between 17 and 19 years of age, living in the Netherlands. We implement a difference-in-discontinuity design that exploits an increase in the deductible of about 180 euros, between 2009 and 2014, and the deductible exemption for those below 18 years old. Finally, we study subgroup effects by household income, level of mental health care expenditure and medication use for mental disorders. Results: Our results show that increasing deductibles reduced the probability of mental health care use at the transition to adulthood by 13.6% for females (−13.6%, CI 95%: −22.1%, −5.2%), and by 5.3% for males (−5.3%, CI 95%: −11.8%, 1.2%). The reduction was larger among females in the lowest (−18.9%, CI 95%: −35.4%, −2.3%) and second lowest (−21.3%, CI 95%: –36.7%, −5.9%) income quartiles. Additionally, we find increased treatment cessation in high deductible years to happen across all levels of mental health care need. Conclusions: Our findings indicate that cost-sharing is compounding to existing disruptions in care at the transition between children/adolescent and adult services. The larger reductions in mental health care use among low-income females uncover the role of the deductible increase in widening mental health care inequalities. Increased treatment cessation even among high-intensity users suggests potential long-term consequences for individuals, the health system, and society.

Original languageEnglish
Article number114741
JournalSocial Science and Medicine
Volume296
DOIs
Publication statusPublished - Mar 2022

Bibliographical note

Funding Information:
This study was funded by the Erasmus Initiative Smarter Choices for Better Health . CRH received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska Curie grant agreement No 707404 . Part of this work was completed while TVO was a visiting scholar at the Milken Institute School of Public Health of the George Washington University. The authors would like to thank seminar participants at Erasmus University Rotterdam, Erasmus MC, Essen Economics of Mental Health Workshop (2020) and EuHEA Student Supervisor and Early Career Research Conference 2020 for useful comments and suggestions.

Funding Information:
This study was funded by the Erasmus Initiative Smarter Choices for Better Health. CRH received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska Curie grant agreement No 707404. Part of this work was completed while TVO was a visiting scholar at the Milken Institute School of Public Health of the George Washington University. The authors would like to thank seminar participants at Erasmus University Rotterdam, Erasmus MC, Essen Economics of Mental Health Workshop (2020) and EuHEA Student Supervisor and Early Career Research Conference 2020 for useful comments and suggestions.

Publisher Copyright:
© 2022 The Authors

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