The effect of copayments on the utilization of the GP service in Norway

We examine the effect of copayment on the utilization of the GP service in Norway. We use a regression discontinuity design to study two key aspects of the policy. First, we examine the overall effect of copayments on total utilization of the GP service. Second, we look at how this effect varies across different patient groups according to medical necessity. Data consists of 5,5 million GP visits for youths aged 10-20 over the 6 year period 2009-2014. We find that the introduction of a co-payment leads to an overall reduction of GP visits of 10-15%. The effect is heterogeneous across patient groups. Patients with an acute condition exhibit low price sensitivity. Patients with general complaints and symptoms, chronic diseases and psychological diseases all react strongly to the copayment. The two latter groups capture patients with conditions that typically warrant medical attention. This paper thus suggests that the current flat fee copayment policy is inefficient at targeting unnecessary use of the GP service at the cost of patients with real medical concerns.