title: Barrier to Access or Cost Share? Coinsurance and Dental-Care Utilization in Colombia.
abstract: BACKGROUND
  Copayments, deductibles, and coinsurance, are elements of health-care systems to make prices salient for the insured. Individuals may respond differently to cost sharing, according to the type of care they seek; dental care, as a combination of both acute and elective care, is an ideal setting to study the effects of cost-sharing mechanisms on utilization.
  
  
  OBJECTIVE
  To test how coinsurance affects dental-care utilization in a middle-income country context.
  
  
  METHODS
  This study uses policy variations in the Colombian health-care system to analyze changes in dental-care utilization due to different levels of coinsurance. We used matching procedures to balance observed differences in pre-treatment variables between those who face coinsurance (non-policy holders, or beneficiaries) and those who don't (policyholders). We use zero-inflated negative binomial models for the count of visits and two-part models for total expenditures, and test for unobservable confounders with random-effect models and instrumental variables.
  
  
  RESULTS
  Individuals who face coinsurance are less likely to have any dental-care utilization, at a relatively small scale. Facing coinsurance does not correlate with changes in total expenditures. Falsification tests with dental-care visits exempt from coinsurance show no statistically distinguishable changes in utilization. Random-effect models and instrumental variable models show results similar to the main specification.
  
  
  CONCLUSIONS
  Cost-sharing policies in Colombia seem to be well designed because they don't represent an important barrier to dental-care access.
authors.affiliation: Division of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, 55455, USA. higue003@umn.edu.
authors.forename: Lucas
authors.initials: L
authors.lastname: Higuera
authors.affiliation: Facultad de Ciencias Administrativas y Económicas, Departamento de Economía, Universidad ICESI & PROESA, Calle 18 No. 122-135, Código postal 760031, Cali, Colombia.
authors.forename: Sergio Iván
authors.initials: SI
authors.lastname: Prada
mesh_terms: D000328:Adult; D003105:Colombia; D017047:Cost Sharing / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D003669:Deductibles and Coinsurance / Q000191:economics*; D003729:Dental Care / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007347:Insurance, Dental / Q000191:economics*; D008297:Male