The impact of transitions in insurance coverage on GP visiting among children in Ireland

- The majority of the Irish population pay the full out-of-pocket cost of GP care.
- Research suggests that child health insurance is associated with improved outcomes.
- We implement difference-in-difference propensity score methods for Irish children.
- Significant effects of changes in GP user fees on GP utilisation are identified.
- The results have implications for current Irish policy on universal healthcare.

The use of direct out-of-pocket payments to finance general practitioner (GP) care by the majority of the population in Ireland is unusual in a European context. Currently, approximately 40 per cent of the population have means-tested access to free GP care, while the remainder must pay the full out-of-pocket cost. In this paper, we use nationally representative data from the Growing up in Ireland (GUI) study to examine the impact of transitions in insurance coverage on GP utilisation among children. GUI surveys two cohorts of nearly 20,000 children (aged 9 months and 9 years at baseline); we use data from the first two waves of each cohort (which covers the period 2007-2012). Using difference-in-difference propensity score matching methods, we find significant effects of changes in public health insurance coverage on GP utilisation (i.e., introducing user fees reduces utilisation, while removing them increases utilisation). The results have direct implications for current Irish health policy, and add to the international literature on the effects of insurance on healthcare utilisation.