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Analyzing regional variation in health care utilization using (rich) household microdata

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  • Eibich, Peter
  • Ziebarth, Nicolas R.

Abstract

This paper exploits rich SOEP microdata to analyze state-level variation in health care utilization in Germany. Unlike most studies in the field of the Small Area Variation (SAV) literature, our approach allows us to net out a large array of individual-level and state-level factors that may contribute to the geographic variation in health care utilization. The raw data suggest that state-level hospitalization rates vary from 65 to 165 percent of the national mean. Ambulatory doctor visits range from 90 to 120 percent of the national mean. Interestingly, in the former GDR states, doctor visit rates are significantly below the national mean, while hospitalization rates lie above the national mean. The significant state-level differences vanish once we control for individual-level socio-economic characteristics, the respondents’ health status, their health behavior as well as supply-side state-level factors.

Suggested Citation

  • Eibich, Peter & Ziebarth, Nicolas R., 2014. "Analyzing regional variation in health care utilization using (rich) household microdata," Health Policy, Elsevier, vol. 114(1), pages 41-53.
  • Handle: RePEc:eee:hepoli:v:114:y:2014:i:1:p:41-53
    DOI: 10.1016/j.healthpol.2013.04.015
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    1. Martin Spieß & Martin Kroh & Rainer Pischner & Gert G. Wagner, 2008. "On the Treatment of Non-Original Sample Members in the German Household Panel Study (SOEP): Tracing, Weighting, and Frequencies," SOEPpapers on Multidisciplinary Panel Data Research 98, DIW Berlin, The German Socio-Economic Panel (SOEP).
    2. Amitabh Chandra & Douglas O. Staiger, 2007. "Productivity Spillovers in Health Care: Evidence from the Treatment of Heart Attacks," Journal of Political Economy, University of Chicago Press, vol. 115, pages 103-140.
    3. Schreyögg, Jonas & Grabka, Markus M., 2010. "Copayments for Ambulatory Care in Germany: A Natural Experiment Using a Difference-in-Difference Approach," EconStor Open Access Articles, ZBW - German National Library of Economics, pages 331-341.
    4. Mercuri, Mathew & Natarajan, Madhu K. & Norman, Geoff & Gafni, Amiram, 2012. "An even smaller area variation: Differing practice patterns among interventional cardiologists within a single high volume tertiary cardiac centre," Health Policy, Elsevier, vol. 104(2), pages 179-185.
    5. Stargardt, Tom & Schreyögg, Jonas, 2012. "A framework to evaluate the effects of small area variations in healthcare infrastructure on diagnostics and patient outcomes of rare diseases based on administrative data," Health Policy, Elsevier, vol. 105(2), pages 110-118.
    6. Filippini, Massimo & Masiero, Giuliano & Moschetti, Karine, 2006. "Socioeconomic determinants of regional differences in outpatient antibiotic consumption: Evidence from Switzerland," Health Policy, Elsevier, vol. 78(1), pages 77-92, August.
    7. Abe C. Dunn & Adam Shapiro & Eli Liebman, 2011. "Geographic Variation in Commercial Medical Care Expenditures: A Decomposition Between Price and Utilization," BEA Working Papers 0075, Bureau of Economic Analysis.
    8. Westert, Gert P. & Groenewegen, Peter P., 1999. "Regional disparities in health care supply in eleven European countries: does politics matter?," Health Policy, Elsevier, vol. 47(2), pages 169-182, May.
    9. Folland, Sherman & Stano, Miron, 1989. "Sources of small area variations in the use of medical care," Journal of Health Economics, Elsevier, vol. 8(1), pages 85-107, March.
    10. Stano, Miron, 1993. "Evaluating the policy role of the small area variations and physician practice style hypotheses," Health Policy, Elsevier, vol. 24(1), pages 9-17, April.
    11. Nicolas Ziebarth & Markus Grabka, 2009. "In Vino Pecunia? The Association Between Beverage-Specific Drinking Behavior and Wages," Journal of Labor Research, Springer, vol. 30(3), pages 219-244, September.
    12. Wennberg, John E. & Barnes, Benjamin A. & Zubkoff, Michael, 1982. "Professional uncertainty and the problem of supplier-induced demand," Social Science & Medicine, Elsevier, vol. 16(7), pages 811-824, January.
    13. Nicolas R. Ziebarth, 2009. "Measurement of Health, the Sensitivity of the Concentration Index, and Reporting Heterogeneity," SOEPpapers on Multidisciplinary Panel Data Research 211, DIW Berlin, The German Socio-Economic Panel (SOEP).
    14. Joachim Frick & Nicolas Ziebarth, 2013. "Welfare-related health inequality: does the choice of measure matter?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(3), pages 431-442, June.
    15. Roll, Kathrin, 2012. "The influence of regional health care structures on delay in diagnosis of rare diseases: The case of Marfan Syndrome," Health Policy, Elsevier, vol. 105(2), pages 119-127.
    16. Martin Kroh, 2011. "Documentation of Sample Sizes and Panel Attrition in the German Socio Economic Panel (SOEP) (1984 until 2010)," Data Documentation 59, DIW Berlin, German Institute for Economic Research.
    17. Matthias Nübling & Hanfried H. Andersen & Axel Mühlbacher & Jürgen Schupp & Gert G. Wagner, 2007. "Computation of Standard Values for Physical and Mental Health Scale Scores Using the SOEP Version of SF12v2," Schmollers Jahrbuch : Journal of Applied Social Science Studies / Zeitschrift für Wirtschafts- und Sozialwissenschaften, Duncker & Humblot, Berlin, vol. 127(1), pages 171-182.
    18. Hirst, Nicholas & Gordon, Louisa & Gies, Peter & Green, Adle C., 2009. "Estimation of avoidable skin cancers and cost-savings to government associated with regulation of the solarium industry in Australia," Health Policy, Elsevier, vol. 89(3), pages 303-311, March.
    19. Sundmacher, Leonie & Busse, Reinhard, 2011. "The impact of physician supply on avoidable cancer deaths in Germany. A spatial analysis," Health Policy, Elsevier, vol. 103(1), pages 53-62.
    20. Epstein, Andrew J. & Nicholson, Sean, 2009. "The formation and evolution of physician treatment styles: An application to cesarean sections," Journal of Health Economics, Elsevier, vol. 28(6), pages 1126-1140, December.
    21. Ziebarth, Nicolas, 2010. "Measurement of health, health inequality, and reporting heterogeneity," Social Science & Medicine, Elsevier, vol. 71(1), pages 116-124, July.
    22. Augurzky, Boris & Bauer, Thomas K. & Schaffner, Sandra, 2006. "Copayments in the German Health System - Do They Work?," RWI Discussion Papers 43, RWI - Leibniz-Institut für Wirtschaftsforschung.
    23. Farbmacher, Helmut, 2009. "Copayments for doctor visits in Germany and the probability of visiting a physician - Evidence from a natural experiment," Discussion Papers in Economics 10951, University of Munich, Department of Economics.
    24. Hendrik Jürges, 2007. "True health vs response styles: exploring cross-country differences in self-reported health," Health Economics, John Wiley & Sons, Ltd., vol. 16(2), pages 163-178.
    25. Augurzky, Boris & Bauer, Thomas K. & Schaffner, Sandra, 2006. "Copayments in the German Health System: Does It Work?," IZA Discussion Papers 2290, Institute for the Study of Labor (IZA).
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    Cited by:

    1. Schurer, Stefanie, 2017. "Bouncing back from health shocks: Locus of control and labor supply," Journal of Economic Behavior & Organization, Elsevier, vol. 133(C), pages 1-20.
    2. Salm, Martin & Wübker, Ansgar, 2017. "Causes of regional variation in healthcare utilization in Germany," Ruhr Economic Papers 675, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    3. Eibich, Peter & Ziebarth, Nicolas, 2014. "Examining the Structure of Spatial Health Effects in Germany Using Hierarchical Bayes Models," EconStor Open Access Articles, ZBW - German National Library of Economics, pages 305-320.
    4. Lavergne, Miriam Ruth & Barer, Morris & Law, Michael R. & Wong, Sabrina T. & Peterson, Sandra & McGrail, Kimberlyn, 2016. "Examining regional variation in health care spending in British Columbia, Canada," Health Policy, Elsevier, vol. 120(7), pages 739-748.

    More about this item

    Keywords

    Small Area Variation; Health care utilization; SOEP;

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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