Cost-Sharing Design Matters: A Comparison of the Rebate and Deductible in Healthcare

Minke Remmerswaal, Jan Boone, Michiel Bijlsma, R.C.M.H. Douven

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Since 2006, the Dutch population has faced two different cost-sharing schemes in health insurance for curative care: a mandatory rebate of 255 euros in 2006 and 2007, and since 2008 a mandatory deductible. Using administrative data for the entire Dutch population, we compare the effect of both cost-sharing schemes on healthcare consumption between 2006 and 2013. We use a regression discontinuity design which exploits the fact that persons younger than eighteen years old neither face a rebate nor a deductible. Our fixed effect
estimate shows that for individuals around the age of eighteen, a one euro increase of the deductible reduces healthcare expenditures 18 eurocents more than a euro increase of the rebate. These results demonstrate that differences in the design of a cost-sharing scheme can lead to substantial different effects on total healthcare expenditure.
Original languageEnglish
Place of PublicationTilburg
PublisherCentER, Center for Economic Research
Number of pages57
Publication statusPublished - 11 Dec 2017

Publication series

NameCentER Discussion Paper


  • deductible
  • rebate
  • cost-sharing
  • healthcare consumption
  • regression discontinuity
  • panel data


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