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In this study, we estimate the effect that the recent increase in co-payments had on the demand for ED care by double insured ADSE (civil servants) patients, who have a private alternative in their plan's network.
Furthermore, we did not consider the fact that some patients that visited the ED using the NHS may be enrolled in a private health plan and, in this sense, may be also double insured.
Our evidence on opting-out behaviour by double insured ADSE patients is consistent with the work of previous authors and provides another practical example of the Besley and Coate (1991) argument [11].
To our knowledge, however, any differential behavior on the demand for care among these double insured patients when co-payments for the public sector increase has never been reported.
Our finding of a 20%% decrease in double-insured ADSE demand is sizeable, but is within the range of the estimates of other authors: Sogaard and colleagues [14] report that in Denmark employer-paid health insurances led to a 10%% reduction of public hospitals while Fabbri and Monfardini [12] estimate that double insured Italian patients may reduce public demand by as much as 70%%.
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