Many health systems adopt cost-sharing plans – requiring individuals to pay a part of the costs of medical services – to tackle the problem of overconsumption. It is not clear how effective cost-sharing is since the empirical evidence is mainly based on the US system, quite different from the European systems. Using an Italian dataset of about 87000 individuals for 2013, we investigate to what extent the exemption from cost-sharing affects the demand for health services. Estimating a model with Instrumental Variables, we exploit the threshold of age 65 giving complete exemption from cost-sharing, comparing the demand for health services by individuals below and above age 65. We find that individuals with exemption significantly increase their demand for specialist visits, diagnostic checks and drug consumption. This is probably due to the attempt of individuals to over-protect against very low health risks, when they bear no cost.

许多卫生系统采用费用分摊计划——要求个人支付部分医疗服务费用——来解决过度消费的问题。目前尚不清楚成本分摊的有效性，因为经验证据主要基于美国系统，与欧洲系统大不相同。我们使用 2013 年约 87000 人的意大利数据集，调查免除费用分摊对卫生服务需求的影响程度。使用工具变量估计模型，我们利用 65 岁的门槛，完全免除费用分摊，比较 65 岁以下和以上个人对医疗服务的需求。我们发现有豁免的个人显着增加了他们对专科医生的需求，诊断检查和药物消耗。