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Evaluating the Impact of Eligibility for Free Care on the Use of GP Services in Ireland: A Difference-in-Difference Matching Approach

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Author Info
Nolan, Anne () (Economic and Social Research Institute (ESRI))

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Abstract

In Ireland, approximately 30 per cent of the population (“medical card patients”) are entitled to free GP care while the remaining 70 per cent (“private patients”) must pay the full cost of each visit. While previous research has analysed the effect of this system on GP visiting patterns using regression methods, to date, no attempt has been made to apply techniques from the treatment evaluation literature to this issue. Treatment evaluation techniques are commonly employed when observations are not randomly assigned to treatment and control groups; this is certainly the case here, as the primary criterion for medical card eligibility is an income below a specified income threshold (and individuals may also be granted medical cards for other reasons such as chronic ill-health). In this paper, we extend previous Irish research, which has analysed the effect of medical card eligibility on GP visiting using regression methods, to consider the use of difference-in-difference matching methods, which allow us to control for non-random selection into treatment and control groups, as well as unobserved differences in characteristics between individuals in both groups. The results are largely consistent with earlier results using pooled cross-sectional and panel data, and confirm that medical card eligibility exerts a significant effect on GP visiting, even after controlling for observed and unobserved differences in characteristics between medical card and private patients.

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Publisher Info
Paper provided by Economic and Social Research Institute (ESRI) in its series Papers with number HRBWP25.

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Length: 27 pages
Date of creation: Oct 2006
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Handle: RePEc:esr:wpaper:hrb25

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Keywords: hrb;

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References listed on IDEAS
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
  1. Richard Blundell & Monica Costa Dias, 2000. "Evaluation methods for non-experimental data," Fiscal Studies, Institute for Fiscal Studies, vol. 21(4), pages 427-468, January. [Downloadable!]
  2. Holger Görg & Eric Strobl, 2005. "Do Government Subsidies Stimulate Training Expenditure? Microeconometric Evidence from Plant Level Data," IZA Discussion Papers 1606, Institute for the Study of Labor (IZA). [Downloadable!]
    Other versions:
  3. David Madden & Anne Nolan & Brian Nolan, 2005. "GP reimbursement and visiting behaviour in Ireland," Health Economics, John Wiley & Sons, Ltd., vol. 14(10), pages 1047-1060. [Downloadable!]
    Other versions:
  4. Antonio Trujillo & Jorge Portillo & John Vernon, 2005. "The Impact of Subsidized Health Insurance for the Poor: Evaluating the Colombian Experience Using Propensity Score Matching," International Journal of Health Care Finance and Economics, Springer, vol. 5(3), pages 211-239, September. [Downloadable!] (restricted)
  5. Nolan, Brian, 1991. "The Utilisation and Financing of Health Services in Ireland," Research Series, Economic and Social Research Institute (ESRI), number GRS155.
  6. A. Nolan & B. Nolan, 2008. "Eligibility for free GP care, “need” and GP visiting in Ireland," The European Journal of Health Economics, Springer, vol. 9(2), pages 157-163, May. [Downloadable!] (restricted)
  7. LaLonde, Robert J, 1986. "Evaluating the Econometric Evaluations of Training Programs with Experimental Data," American Economic Review, American Economic Association, vol. 76(4), pages 604-20, September. [Downloadable!] (restricted)
  8. Anne Nolan, 2007. "A dynamic analysis of GP visiting in Ireland: 1995-2001," Health Economics, John Wiley & Sons, Ltd., vol. 16(2), pages 129-143. [Downloadable!]
  9. Heckman, James J & Ichimura, Hidehiko & Todd, Petra, 1998. "Matching as an Econometric Evaluation Estimator," Review of Economic Studies, Blackwell Publishing, vol. 65(2), pages 261-94, April. [Downloadable!] (restricted)
  10. Nolan, Brian, 1993. "Economic incentives, health status and health services utilisation," Journal of Health Economics, Elsevier, vol. 12(2), pages 151-169, July. [Downloadable!] (restricted)
  11. Rajeev H. Dehejia & Sadek Wahba, 1998. "Causal Effects in Non-Experimental Studies: Re-Evaluating the Evaluation of Training Programs," NBER Working Papers 6586, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
  12. Lechner, Michael & Vazquez-Alvarez, Rosalia, 2003. "The Effect of Disability on Labour Market Outcomes in Germany: Evidence from Matching," IZA Discussion Papers 967, Institute for the Study of Labor (IZA). [Downloadable!]
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  13. Sascha O. Becker & Andrea Ichino, 2002. "Estimation of average treatment effects based on propensity scores," Stata Journal, StataCorp LP, vol. 2(4), pages 358-377, November. [Downloadable!]
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