Carré, Benoît, Florence Jusot, and Jérôme Wittwer. 2025. “ Do Prices Matter for Healthcare Accessibility? Evidence From a Means-Tested Complementary Health Insurance in France,” Health Economics: 1–28. https://doi.org/10.1002/hec.70070.
The study investigates whether healthcare prices affect accessibility by examining the impact of providing free complementary health insurance on healthcare utilization in France. Specifically, it assesses how enrollment in the Couverture Maladie Universelle Complémentaire (CMU-C) — a means-tested, state-funded program that fully covers healthcare costs for low-income individuals — influences the use of medical services.
The researchers use administrative claims data from French healthcare records. A staggered difference-in-differences (DiD) approach is employed to estimate how healthcare utilization changes after individuals enroll in the CMU-C program versus before. To handle the fact that individuals self-select into insurance, the authors exploit health shocks at the family level as a source of exogenous variation in enrollment (i.e., sudden health events that affect insurance take-up but are plausibly unrelated to prior utilization trends).
The researchers tracked the following: the probability of using a given type of healthcare service (the extensive margin), the probability that an individual had any ambulatory (outpatient) care, probability of at least one visit to a general practitioner, the probability of at least one specialist visit, the probability of any pharmacy use, the probability of any dental care use. They also tracked the amount spent on ambulatory care, spending on GP visits spending on specialist visits, and spending on medications.
The paper finds that providing free complementary health insurance (CMU-C) significantly increases healthcare utilization, showing that prices are an important barrier to access. Enrollment in CMU-C raises both the probability of using healthcare (extensive margin) and the amount of care consumed (intensive margin), with particularly large effects among individuals who were previously uninsured. Utilization gains are also substantial for people with severe or chronic health conditions, despite existing public coverage mechanisms for these groups. Importantly, the increase in healthcare use persists over time rather than being a short-term adjustment, indicating a sustained improvement in access to care once out-of-pocket prices are eliminated.
The findings support the idea that price barriers matter for healthcare access: eliminating out-of-pocket costs through free complementary insurance increases both the likelihood and intensity of care use, particularly among previously uninsured and vulnerable populations. This implies that subsidizing healthcare costs can improve accessibility and potentially reduce unmet needs in low-income groups.
Author's Note
The overall results of this study were not surprising. Humans in general love free stuff, due to our naturally profit-maximizing behavior. I personally feel that the data from this study can be interpreted in different ways--is this "profit-maximizing" behavior harmful, as everyone tries to use up all the hospital resources and doesn't leave enough resources for others? Or, does this data have greater connotations for the private insurance system, where patients are not receiving adequate resources for their health?
I feel like this study should do a follow-up investigation on the necessity ranking of the patients' medical resource usage.. Overall, the paper was easy to read, exceptionally well-explained, and had demonstrative graphs of the data.
I wonder how much the government's insurance policies will refer to this paper, and if it will make a difference as they update/reform their insurance system.
Especially in countries such as the United States, China, India, and Mexico, where healthcare is not public, a large part of their decision is definitely due to the large size of their population. I doubt it will be possible to shift their insurance systems to a public one without allocating a large part of their government expenditures.
Overall, this paper really made me reflect on the many benefits, yet also the negatives, of public healthcare. In the end, the goal is to make healthcare accessible for those who don't have access, not for monetary or profitable reasons, so research is essential to map out human behavior in such contexts.