Use of Elective Surgery in Public hospitals:Modeling Access-Cost Quality Trade-offs in a Spatial Framework
AbstractThe overall objective of the paper is to model and econometrically analyze the impact of access costs (travel time to hospital) and quality of health care on the utilization of elective health services in public hospitals. We argue that patients might face a trade-off between better perceived quality of care and access costs. The extant literature has not yet developed a common framework which explicitly incorporates the quality and access trade-off. The first aim of this paper is to help fill this gap. We propose a stylized model where GPs and Specialists act as gatekeepers, waiting times act as a rationing device; and perception of quality and access costs contributes to the choice of hospital for treatment. A secondary objective of the paper is to explore econometric approaches to simultaneously deal with access cost quality tradeoff and its effect on patient flows across regions. The geographic access costs lead to interaction between regions which is termed as spatial dependence. This is econometrically tested by applying spatial regression techniques focussing on spatial panel models recently proposed but not yet been widely applied to health economics. The results show that spatial effects especially the geographic neighborhood effects significantly affect the hospital utilization rates at a regional level. Travel time is found to have significant and negative effect on hospital utilization for some Diagnostic categories. The effect of quality of care (measured by the rate of adverse events) is negative and significant for one category of separations. However the effect is quantitatively small. We do not find any evidence of trade-off between quality and travel time for all category of separations. Policy implications are discussed..
Download InfoIf you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
Bibliographic InfoPaper provided by Monash University, Centre for Health Economics in its series Centre for Health Economics Research Papers with number 26/08.
Length: 38 pages
Date of creation: Mar 2008
Date of revision:
Contact details of provider:
Postal: Centre for Health Economics, Monash University, Building 75, Clayton, Victoria 3800, Australia
Web page: http://www.buseco.monash.edu.au/centres/che/
More information through EDIRC
This paper has been announced in the following NEP Reports:
- NEP-ALL-2008-04-15 (All new papers)
- NEP-GEO-2008-04-15 (Economic Geography)
- NEP-HEA-2008-04-15 (Health Economics)
- NEP-URE-2008-04-15 (Urban & Real Estate Economics)
You can help add them by filling out this form.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Teresa Cheong).
If references are entirely missing, you can add them using this form.