Background Compared with the number of studies performed in the United States, few studies have been conducted on the link between health insurance and healthcare consumption in Europe, likely because most European countries have compulsory national health insurance (NHI) or a national health service (NHS). Recently, a major French private insurer, offering voluntary complementary coverage in addition to the compulsory NHI, replaced its single standard package with a range of offers from basic coverage (BC) to extended coverage (EC), providing a quasi-natural experiment to test theoretical assumptions about consumption patterns. Methods Reimbursement claim data from 85,541 insurees were analysed from 2009 to 2018. Insurees who opted for EC were matched to those still covered by BC with similar characteristics. Difference-in-differences (DiD) models were used to compare both the monetary value and physical quantities of healthcare consumption before and after the change in coverage. Results As expected, the DiD models revealed a strongly significant, though transitory (mainly during the first year), increase after the change in coverage for EC insurees, particularly for costly care such as dental prostheses and spectacles. Surprisingly, consumption seemed to precede the change in coverage, suggesting that one possible determinant of opting for more coverage may be previous unplanned expenses. Conclusion Both catching-up behaviour and moral hazard are likely to play a role in the observed increase in healthcare consumption.

中文翻译：

---

健康保险承保范围变更后的医疗保健消费：法国的准自然实验。

背景与美国进行的研究相比，在欧洲很少进行有关健康保险与医疗保健消费之间联系的研究，这很可能是因为大多数欧洲国家都拥有强制性的国民健康保险（NHI）或国民健康服务（NHS） ）。最近，一家主要的法国私人保险公司除了提供强制性的NHI之​​外，还提供自愿补充保险，以从基本保险（BC）到扩展保险（EC）的一系列优惠取代了其单一标准配套，提供了一种准自然试验来测试关于消费模式的理论假设。方法分析2009年至2018年来自85,541名被保险人的报销索赔数据。选择EC的被保险人与仍具有BC相似特征的被保险人相匹配。差异率（DiD）模型用于比较保险范围变更前后的医疗保健消费的货币价值和实物数量。结果正如预期的那样，DiD模型显示出非常显着的变化，尽管是短暂的（主要是在第一年），但在EC受保人，特别是昂贵的护理（例如假牙和眼镜）的承保范围发生变化后，DiD模型却有所增加。出人意料的是，消费似乎是在承保范围变化之前发生的，这表明选择更多承保范围的一个可能决定因素可能是先前的计划外支出。结论追赶行为和道德风险均可能在观察到的医疗保健消费增加中起作用。