Nadine Reibling, Claus Wendt
Access Regulation and Utilization of Healthcare Services
Regulating patients’ access to healthcare has been used in several countries as a way of controlling patients’ consumption levels. In some countries, provider choice is directly limited through legal regulations such as gatekeeping, whereas in other countries patients’ behavior is primarily governed by financial incentives like co-payments to doctor visits. However, empirical studies, mostly conducted in the United States, do not provide a clear answer whether institutional access regulations actually accomplish a reduction of used health services. The objective of this paper is to assess the impact of access regulations on healthcare utilization in a cross-national framework comparing eleven European countries. While access restrictions are assumed to have an effect on the overall level of utilization, they can also have an impact on the equity of utilization between different socio-economic groups. Our analyses combine institutional indicators on the country level and number of doctor visits on the micro-level from the first wave of SHARE. The results show that access regulations and especially gatekeeping systems are associated with a lower level of overall service usage. Gatekeeping systems also reduce inequity in specialist visits across groups with different levels of education. Contrary to theoretical expectations but in line with earlier studies cost sharing could not be related to inequity patterns across income groups.