title: Free Medicines Thanks to Retirement: Impact of Coinsurance Exemption on Pharmaceutical Expenditures and Hospitalization Offsets in a national health service.
abstract: This paper examines the impact of coinsurance exemption for prescription medicines applied to elderly individuals in Spain after retirement. We use a rich administrative dataset that links pharmaceutical consumption and hospital discharge records for the full population aged 58 to 65 years in January 2004 covered by the public insurer in a Spanish region, and we follow them until December 2006. We use a difference-in-differences strategy and exploit the eligibility age for Social Security to control for the endogeneity of the retirement decision. Our results show that this uniform exemption increases the consumption of prescription medicines on average by 17.5%, total pharmaceutical expenditure by 25% and the costs borne by the insurer by 60.4%, without evidence of any offset effect in the form of lower short term probability of hospitalization. The impact is concentrated among consumers of medicines for acute and other non-chronic diseases whose previous coinsurance rate was 30% to 40%. Copyright © 2015 John Wiley & Sons, Ltd.
authors.affiliation: Department of Economics and Business, Research Centre on Economics and Health (CRES), Universitat Pompeu Fabra, Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Puig-Junoy
authors.affiliation: Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands.|Tinbergen Institute, Rotterdam, The Netherlands.
authors.forename: Pilar
authors.initials: P
authors.lastname: García-Gómez
authors.affiliation: Institut d'Avaluació de Polítiques Públiques (IVALUA), Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Casado-Marín
mesh_terms: D003669:Deductibles and Coinsurance / Q000191:economics*; D016527:Drug Costs; D004363:Drug Utilization / Q000191:economics; D005102:Health Expenditures; D006760:Hospitalization; D006801:Humans; D007182:Income; D008875:Middle Aged; D009313:National Health Programs; D010351:Patient Discharge; D012179:Retirement / Q000191:economics*; D013030:Spain
keywords: cost sharing; healthcare expenditure; hospitalization offsets; pharmaceuticals