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CINCH - Health Economics Research Center

New CINCH working paper


A new working paper has been added to the CINCH working paper series: “Does the framing of patient cost-sharing incentives matter? The effects of deductibles vs. no-claim refunds” by Arthur P. Hayen, Tobias J. Klein, and Martin Salm.

Abstract: Understanding how health care utilization responds to cost-sharing incentives is of central importance for providing high quality care and limiting the growth of costs. While there is compelling evidence that patients react to financial incentives, it is less well understood how and why specific aspects of the design of contracts shape the size of this reaction. In this paper, we focus on the question whether the framing of cost-sharing incentives has an effect on health care utilization. To study this, we make use of a policy change that occurred in the Netherlands. Until 2007, patients received a no-claim refund if they consumed little or no health care; from 2008 onward there was a deductible instead. This means that very similar economic incentives were first framed in terms of smaller gains and later as losses. We use claims-level data for a broad sample from the Dutch population to estimate whether the reaction to economic incentives was affected by this. Our empirical approach is to exploit within-year variation using an instrumental variables approach while controlling for differences across years. Our central finding is that patients react to incentives much more strongly when they are framed in terms of losses. Simulations based on our estimates show that the effect on yearly spending is 8.6 percent. This suggests that discussions on the optimal design of cost-sharing incentives should not only involve coinsurance rates and cost-sharing limits, but also how these are presented to patients.

See all working papers.

Essen Health Economics Seminar @ CINCH Essen


On Friday, July 5 2019, 14:00 - 15:30, Amitabh Chandra (Harvard University) will present a research project entitled:


Market Forces in Health Care


Room: WST-C.02.12, Weststadttürme Berliner Platz 6-8, Essen

To find more on upcoming seminars, click here.

Essen Health Economics Seminar @ CINCH Essen


On Monday, July 1 2019, 14:00 - 15:30, Nicolas Ziebarth (Cornell University) will present:

Biased Health Perceptions and Risky Health Behaviors - Theory and Evidence

This paper investigates biased health perceptions as a potential driving force of risky health behavior. We define absolute and relative health perception biases and illustrate their measurement in surveys. Next, we theoretically show that risky behavior increases in health perception biases when such biases induce people to underestimate the marginal costs of risky behavior. Using evidence from three different surveys, we provide robust empirical evidence that respondents who overestimate their health are less likely to exercise; they are more likely to eat unhealthy and to have higher BMIs. Moreover, they sleep fewer hours and drink alcohol more often.

Room: WST-A.02.04, Weststadttürme Berliner Platz 6-8, Essen

To find more on upcoming seminars, click here.