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Why do patients prefer hospital emergency visits? A nested multinomial logit analysis for patient‐initiated contacts

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  • Jaume Puig‐Junoy

    ()

  • Marc Saez
  • Esther Martínez‐García

    ()

Abstract

This 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. Copyright Kluwer Academic Publishers 1998

Suggested Citation

  • Jaume Puig‐Junoy & Marc Saez & Esther Martínez‐García, 1998. "Why do patients prefer hospital emergency visits? A nested multinomial logit analysis for patient‐initiated contacts," Health Care Management Science, Springer, vol. 1(1), pages 39-52, September.
  • Handle: RePEc:kap:hcarem:v:1:y:1998:i:1:p:39-52
    DOI: 10.1023/A:1019082232606
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    Citations

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    Cited by:

    1. Emily Lancsar, 2002. "Deriving welfare measures from stated preference discrete choice modelling experiments, CHERE Discussion Paper No 48," Discussion Papers 48, CHERE, University of Technology, Sydney.
    2. Ángel López-Nicolás & Marcos Vera-Hernández, 2002. "Are tax subsidies for private medical insurance self-financing? Evidence from a microsimulation model for outpatient and inpatient episodes," Economics Working Papers 632, Department of Economics and Business, Universitat Pompeu Fabra, revised Oct 2004.
    3. Matthew Berman & Andrea Fenaughty, 2005. "Technology and managed care: patient benefits of telemedicine in a rural health care network," Health Economics, John Wiley & Sons, Ltd., vol. 14(6), pages 559-573.
    4. Lippi Bruni, Matteo & Mammi, Irene & Ugolini, Cristina, 2016. "Does the extension of primary care practice opening hours reduce the use of emergency services?," Journal of Health Economics, Elsevier, vol. 50(C), pages 144-155.
    5. repec:kap:hcarem:v:21:y:2018:i:2:d:10.1007_s10729-017-9399-1 is not listed on IDEAS
    6. Marisol Rodríguez & Alexandrina Stoyanova, 2004. "The effect of private insurance access on the choice of GP|specialist and public|private provider in Spain," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 689-703.
    7. Marc Saez & Carme Saurina & Germà Coenders & Sònia González-Raya, 2006. "Use of primary health care services according to the different degrees of obesity in the Girona Health Region, Spain," Health Economics, John Wiley & Sons, Ltd., vol. 15(2), pages 173-193.
    8. Aïda Solé-Auró & Montserrat Guillén & Eileen Crimmins, 2012. "Health care usage among immigrants and native-born elderly populations in eleven European countries: results from SHARE," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(6), pages 741-754, December.
    9. Marcos Singer & Patricio Donoso & Natalia Jadue, 2004. "Evaluacion De Las Oportunidades De Mejoramiento De La Logistica Directa De Emergencia," Abante, Escuela de Administracion. Pontificia Universidad Católica de Chile., vol. 7(2), pages 179-209.
    10. Pedro Ramos & Álvaro Almeida, 2014. "The Impact of An Increase in User Costs on the Demand For Emergency Services: The Case of Portuguese Hospitals," FEP Working Papers 531, Universidade do Porto, Faculdade de Economia do Porto.

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