The Implementation of Cost-Sharing Systems in Europe and the Spanish Dilemma

Advanced economies face profound economic, budgetary and social risks, which are at the center of the debates about the sustainability of our healthcare and social protection systems. Reforms in healthcare markets' organization, coverage and regulation are appearing everywhere. One of them deals with the role of cost-sharing in healthcare systems. This case takes advantage of the differences in cost-sharing mechanisms existing today across the different European healthcare systems to analyze the impact that copayments can have on the utilization of health services and on the health of the population. Ultimately, it aims to provide an understanding of the role of different price elasticities for different types of health services and patients. The goal is to be able to answer the following three questions: (a) Why are governments considering the possibility of cost-sharing? (b) Who should be paying? and (c) For which type of healthcare services? To do so it focuses on the situation faced by the Spanish government in June 2012, when it had to decide whether to expand cost-sharing beyond medical drugs.