An agent-based simulation model to evaluate alternative co-payment scenarios for contributing to health systems financing

Abstract

Ageing populations, rapid technological progress and recent public budget cuts currently threaten the sustainability of public health systems. To meet growing needs with declining resources, decision-makers must identify new ways to avoid reducing the quality of services offered to citizens. This paper focuses on the so-called “co-payment” tools aimed to obtain additional resources for the public health budget directly from citizens. Whereas certain forms of co-payments have always been introduced within health systems to prevent moral hazard behaviours, other co-payment mechanisms are explicitly intended to help finance public healthcare systems. Literature and empirical findings do not agree about the final impact of such co-payment tools, particularly whether they can attain system sustainability and guarantee equitably delivered services. In this paper, we develop an agent-based simulation model which can be used by decision-makers as a decision support tool to compare different co-payment rules and evaluate their impact on the public budget and the health expense of different groups of citizens.

Keywords:

• health economics
• agent-based simulation
• decision support system
• health system financing

Acknowledgments

We wish to thank GP Ligurnet—especially Pierclaudio Brasesco for collaboration in data supply. All authors acknowledge and appreciate the grant support of the Italian Ministry of Education, Universities and Research (MIUR), within the FIRB project N. RBFR08IKSB.