The impact of age-based financing of screening tests on utilization and outcomes: the case of amniocentesis

How does age-based financing of screening tests affect test utilization and outcomes? We use the variation over time and the sharp cross-sectional change in eligibility that were induced by a 1993 policy change in Israel’s public healthcare system that lowered the eligibility age for amniocentesis testing from 37 to 35, to draw causal inference about this issue in a setting where financing may distort a woman’s incentive to acquire information about her degree of risk. Financing is found to have increased amniocentesis testing by 35%. At ages above the eligibility threshold, utilization rates rose to roughly 33%, reflection nearly full takeup among prospective users of amniocentesis. Additionally, whereas below the age-35 threshold amniocentesis utilization rates increase with maternal age, this relation is muted above this age. Finally, no evidence is found that financing affects outcomes such as pregnancy terminations and births of children with Down syndrome. These results support the view that women above the eligibility threshold tend to refrain from acquiring inexpensive information about their degree of risk that absent the financing they would acquire, and instead, undergo the accurate and costly test regardless of additional information that noninvasive screening would provide.