The redistributive effects of copayment (superticket): evidence from Lombardy

What is it about?

In Italy, copayment has changed its nature and it can no longer be simply considered a system to curb inappropriate expenditure. It has become an important form of revenue for public health care provision, but it might also become a source of distortions in income and health benefits redistribution. We use a rich administrative dataset gathering information on patients demand (whose records have been matched to income declared for tax purposes) to study the effects of an additional copayment (the so called “superticket” introduced by the Italian government in 2012) in Lombardy, the biggest Italian Region whose socio-economic dimension is comparable to that of many European countries (e.g., the Netherlands, Switzerland, etc.). Our analysis shows that at the aggregate level the non-uniform superticket schedule adopted in Lombardy is slightly pro-poor, but this result coexists with evidences pointing towards possible cases of restriction to access caused by the additional copayment. The introduction of the superticket and the ensuing increase in the out-of pocket payment for health care raises questions about the distribution of the burden among patients, and the sustainability of the extra revenue through time. This issue needs to be further investigated by combining health status data with the information in this dataset.

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Why is it important?

The increase in the out of pocket payment due to the introduction of the superticket raises questions about the distribution of the burden among patients and the barriers to access that it may have created. From the revenue side, in the short run, the policy is sustainable, but competition from private providers casts some doubts on long-run perspectives. On the distribution side, the "paternalistic goods" nature of health care services means that there are two dimensions on which redistribution should be evaluated: (1) the health status measuring the need for care and income, (2) the income effects in the access to health care. Our data do not allow to study the first dimension since the only available health-related information is exemption for pathology. This issue should be furtherly investigated in future research where this dataset might be matched with health status variables in order to assess whether the superticket may also create barriers to the access to health care services. On the second dimension we show that slightly pro-poor, but this result coexists with evidences pointing towards possible cases of restriction to access caused by the additional copayment.