Health care provider choice in the case of patient-initiated contacts. An extended version of discrete choice of model demand
AbstractThis paper analyzes the nature of health care provider choice in the case of patient-initiated contacts, with special reference to a National Health Service setting, where monetary prices are zero and general practitioners act as gatekeepers to publicly financed specialized care. We focus our attention on the factors that may explain the continuously increasing use of hospital emergency visits as opposed to other provider alternatives. An extended version of a discrete choice model of demand for patient-initiated contacts is presented, allowing for individual and town residence size differences in perceived quality (preferences) between alternative providers and including travel and waiting time as non-monetary costs. Results of a nested multinomial logit model of provider choice are presented. Individual choice between alternatives considers, in a repeated nested structure, self-care, primary care, hospital and clinic emergency services. Welfare implications and income effects are analyzed by computing compensating variations, and by simulating the effects of user fees by levels of income. Results indicate that compensating variation per visit is higher than the direct marginal cost of emergency visits, and consequently, emergency visits do not appear as an inefficient alternative even for non-urgent conditions.
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Bibliographic InfoPaper provided by Department of Economics and Business, Universitat Pompeu Fabra in its series Economics Working Papers with number 308.
Date of creation: Jul 1998
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Web page: http://www.econ.upf.edu/
Health care demand; emergency visits; nested multinomial logit; compensating variation; time costs;
Other versions of this item:
- Jaume Puig & Marc Sáez & Esther Martínez Garcia, 1998. "Health care provider choice in the case of patient-initiated contacts. An extended version of discrete choice of model demand," Working Papers, Research Center on Health and Economics 308, Department of Economics and Business, Universitat Pompeu Fabra.
- D12 - Microeconomics - - Household Behavior - - - Consumer Economics: Empirical Analysis
- H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
- I10 - Health, Education, and Welfare - - Health - - - General
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- Dor, Avi & Gertler, Paul & van der Gaag, Jacques, 1987. "Non-price rationing and the choice of medical care providers in rural Cote d'Ivoire," Journal of Health Economics, Elsevier, vol. 6(4), pages 291-304, December.
- S Birch & J Eyles & KM Newbold, 1993. "Equitable Access to Health Care: Methodological Extensions to the Analysis of Physician Utilization in Canada," Centre for Health Economics and Policy Analysis Working Paper Series 1993-03, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
- Gertler, Paul & Locay, Luis & Sanderson, Warren, 1987.
"Are user fees regressive? : The welfare implications of health care financing proposals in Peru,"
Journal of Econometrics,
Elsevier, vol. 36(1-2), pages 67-88.
- Paul J. Gertler & Luis Locay & Warren C. Sanderson, 1987. "Are User Fees Regressive? The Welfare Implications of Health Care Financing Proposals in Peru," NBER Working Papers 2299, National Bureau of Economic Research, Inc.
- Bolduc, Denis & Lacroix, Guy & Muller, Christophe, 1996.
"The choice of medical providers in rural Benin: A comparison of discrete choice models,"
Journal of Health Economics,
Elsevier, vol. 15(4), pages 477-498, August.
- BOLDUC, Denis & LACROIX, Guy & MULLER, Christophe, 1994. "The Choice of Medical Providers in Rural Bénin: a Comparison of Discrete Choice Model," Cahiers de recherche 9411, Université Laval - Département d'économique.
- Kling, Catherine L. & Thomson, Cynthia J., 1996. "Implications of Model Specification for Welfare Estimation in Nested Logit Models (The)," Staff General Research Papers 1599, Iowa State University, Department of Economics.
- Acton, Jan Paul, 1975. "Nonmonetary Factors in the Demand for Medical Services: Some Empirical Evidence," Journal of Political Economy, University of Chicago Press, vol. 83(3), pages 595-614, June.
- Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-77, June.
- Trajtenberg, Manuel, 1989. "The Welfare Analysis of Product Innovations, with an Application to Computed Tomography Scanners," Journal of Political Economy, University of Chicago Press, vol. 97(2), pages 444-79, April.
- Borsch-Supan, Axel, 1990. "On the compatibility of nested logit models with utility maximization," Journal of Econometrics, Elsevier, vol. 43(3), pages 373-388, March.
- Vistnes, Jessica Primoff & Hamilton, Vivian, 1995. "The Time and Monetary Costs of Outpatient Care for Children," American Economic Review, American Economic Association, vol. 85(2), pages 117-21, May.
- Roger Feldman & Michael Finch & Bryan Dowd & Steven Cassou, 1989. "The Demand for Employment-Based Health Insurance Plans," Journal of Human Resources, University of Wisconsin Press, vol. 24(1), pages 115-142.
- Hausman, Jerry & McFadden, Daniel, 1984.
"Specification Tests for the Multinomial Logit Model,"
Econometric Society, vol. 52(5), pages 1219-40, September.
- D. McFadden & J. Hausman, 1981. "Specification Tests for the Multinominal Logit Model," Working papers 292, Massachusetts Institute of Technology (MIT), Department of Economics.
- Van de Ven, Wynand P. M. M. & Van Der Gaag, Jacques, 1982. "Health as an unobservable : A MIMIC-model of demand for health care," Journal of Health Economics, Elsevier, vol. 1(2), pages 157-183, August.
- Cameron, A C & P. K. Trivedi & Frank Milne & J. Piggott, 1988. "A Microeconometric Model of the Demand for Health Care and Health Insurance in Australia," Review of Economic Studies, Wiley Blackwell, vol. 55(1), pages 85-106, January.
- Wedig, Gerard J., 1988. "Health status and the demand for health : Results on price elasticities," Journal of Health Economics, Elsevier, vol. 7(2), pages 151-163, June.
- Winfried Pohlmeier & Volker Ulrich, 1995. "An Econometric Model of the Two-Part Decisionmaking Process in the Demand for Health Care," Journal of Human Resources, University of Wisconsin Press, vol. 30(2), pages 339-361.
- Ann D. Colle & Michael Grossman, 1979. "Determinants of Pediatric Care Utilization," NBER Working Papers 0240, National Bureau of Economic Research, Inc.
- Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-55, March-Apr.
- Germano Mwabu & Martha Ainsworth & Andrew Nyamete, 1993. "Quality of Medical Care and Choice of Medical Treatment in Kenya: An Empirical Analysis," Journal of Human Resources, University of Wisconsin Press, vol. 28(4), pages 838-862.
- Cauley, Stephen Day, 1987. "The Time Price of Medical Care," The Review of Economics and Statistics, MIT Press, vol. 69(1), pages 59-66, February.
- Koning, Ruud H. & Ridder, Geert, 1994. "On the compatibility of nested logit models with utility maximization : A comment," Journal of Econometrics, Elsevier, vol. 63(2), pages 389-396, August.
- Asfaw, Abay & Braun, Joachim von & Klasen, Stephan, 2004. "How Big is the Crowding-Out Effect of User Fees in the Rural Areas of Ethiopia? Implications for Equity and Resources Mobilization," World Development, Elsevier, vol. 32(12), pages 2065-2081, December.
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