The Impact of a Rise in Co-Payments on the Demand for Emergency Services

! ! ! ! THE IMPACT OF A RISE IN CO-PAYMENTS ON THE DEMAND FOR EMERGENCY SERVICES by PEDRO JORGE SALDANHA RAMOS MASTER THESIS IN HEALTH CARE ECONOMICS AND MANAGEMENT ADVISOR: ÁLVARO FERNANDO SANTOS ALMEIDA, Ph.D. 2013 THE IMPACT OF A RISE IN CO-PAYMENTS ON THE DEMAND FOR EMERGENCY SERVICES ! ii ! BRIEF BIOGRAPHICAL INFORMATION The candidate graduated in Basic Health Sciences (1st cycle of the Integrated Master of Medicine) in the Faculty of Medicine of the University of Porto in June 2010. In September 2011, the candidate entered the Master of Health Care Economics and Management in the School of Economics and Management of the University of Porto. In July 2013, he graduated in Medicine (Integrated Master of Medicine) in the Faculty of Medicine of the University of Porto, with the thesis entitled “Dedicated Emergency Room Surgical Team”. THE IMPACT OF A RISE IN CO-PAYMENTS ON THE DEMAND FOR EMERGENCY SERVICES ! iii ! ACKNOWLEDGEMENTS I am extremely grateful to Professor Alvaro Almeida, who supervised my thesis, for his insightful criticism and for advices which helped me define my own career path. I am also grateful to Professor Jose Artur Paiva, Dr. Helena Rodrigues, Dr. Cristina Marujo and Dr. Francisco Sampaio, for their crucial support and guidance. I also thank the Administrations of CHSJ and CHMA for providing the data, and particularly to Dr. Jose Pedro Almeida and to Dr. Antonio Parra for their time and their help on providing technical support on the Hospitals’ data, and to Mrs. Nazaré Pereira and Ms. Sandra Coelho for providing administrative information and assistance. I am grateful to Dr. Manuel Gomes Mota for his support with the GIS data. I am thankful to Sofia Vaz for many hours of talk, invaluable discussion and rare capability of thinking beyond the obvious. “The most decisive actions of our life - I mean those that are most likely to decide the whole course of our future - are, more often than not, unconsidered.” André Gide, Les faux-monnayeurs THE IMPACT OF A RISE IN CO-PAYMENTS ON THE DEMAND FOR EMERGENCY SERVICES ! iv !! RESUMO A criação e o aumento dos co-pagamentos em visitas ao Serviço de Urgência são mecanismos frequentemente utilizados para reduzir o overcrowding dos serviços com episódios (desnecessários) de baixa gravidade. Com esse objetivo, em Novembro de 2011, o Governo de Portugal decretou um aumento dos co-pagamentos em inúmeros serviços disponibilizados pelo Serviço Nacional de Saúde, nomeadamente os Serviços de Urgência, e alterou os critérios de elegibilidade para ser concedida isenção de co-pagamentos, com ambas as alterações a terem início a 1 de Janeiro de 2012. O objetivo desta tese é avaliar o impacto do aumento dos co-pagamentos na procura de Serviços de Urgência em Portugal, no contexto da alteração dos critérios de isenção de co-pagamentos. Palavras-Chave: Serviço Nacional de Saúde; Co-pagamentos; Classificação JEL: I110, I130, I1180 THE IMPACT OF A RISE IN CO-PAYMENTS ON THE DEMAND FOR EMERGENCY SERVICES ! v !! ABSTRACT Creating and increasing the amount of co-payments in Emergency Services are mechanisms often used to reduce overcrowding due to (unnecessary) low-severity visits. With that aim, in November 2011, the Portuguese Government ordered an increase in co-payments for several health services provided by the National Health Service, including Emergency Services, and changed the eligibility criteria for co-payment exemption, both changes taking effect on January 1st 2012. The objective of this thesis is to evaluate the impact of the increase in co-payments on the demand for Emergency Services in Portugal, in the context of a change in the eligibility criteria for co-payment exemption. Keywords: National Health Service; Co-payments JEL Classification: I110, I130, I1180