Utilization of public health centres in Portugal: effect of time costs and other determinants. Finite mixture models applied to truncated samples
The impact of time costs on the utilization of medical care has been a subject of theoretical and empirical research since the early 1970s. The main goal of this paper is to show the effect of time costs on the number of visits to general practitioners (GP) in Portuguese public health centres. We measured the elasticity of primary health care utilization relative to the total time spent in the health centre and relative to travel time. We also provided evidence regarding the impact of an appointment delay on the utilization of public GP services. Our data resulted from the application of an endogenous sampling scheme, resulting in a truncated-at-zero data set. To model our dependent variable, number of visits, and accounting for the truncated nature of the data we used a finite mixture model specification. The data were obtained from the most recent implementation in Portugal of the 2003|2004 Europep Survey. The two-component negative binomial II finite mixture model led to the identification of two different latent classes of health centre users: a low-users class that comprises 88% of patients with an estimated utilization mean of 4.3 GP visits per year and a frequent-users class with an estimated utilization mean of 11.1 visits for the remaining 12% of the population. We failed to find any statistically significant elasticity of time cost utilization, when this variable is measured as the total time spent in the health centre. Regarding the effect of an appointment delay on health centre utilization we concluded that individuals respond to this variable by lowering the number of GP visits. This last finding may have policy implications, which will be discussed at the end of the paper. Copyright © 2005 John Wiley & Sons, Ltd.
Volume (Year): 14 (2005)
Issue (Month): 9 ()
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- Oliveira, Monica Duarte & Bevan, Gwyn, 2003. "Measuring geographic inequities in the Portuguese health care system: an estimation of hospital care needs," Health Policy, Elsevier, vol. 66(3), pages 277-293, December.
- Gurmu, Shiferaw & Trivedi, Pravin K., 1992. "Overdispersion tests for truncated Poisson regression models," Journal of Econometrics, Elsevier, vol. 54(1-3), pages 347-370.
- 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.
- 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.
- Akin, John S, et al, 1986. "The Demand for Primary Health Care Services in the Bicol Region of the Philippines," Economic Development and Cultural Change, University of Chicago Press, vol. 34(4), pages 755-82, July.
- Heckman, James & Singer, Burton, 1984. "A Method for Minimizing the Impact of Distributional Assumptions in Econometric Models for Duration Data," Econometrica, Econometric Society, vol. 52(2), pages 271-320, March.
- Pedro Pita Barros & Pau Olivella, .
"Waiting Lists And Patient Selection,"
UFAE and IAE Working Papers
444.99, Unitat de Fonaments de l'Anàlisi Econòmica (UAB) and Institut d'Anàlisi Econòmica (CSIC).
- Pau Olivella Cunill & Pedro Pita Barros, 2000. "Waiting Lists and Patient Selection," Econometric Society World Congress 2000 Contributed Papers 0283, Econometric Society.
- Barros, Pedro Luis Pita, 2000. "Waiting Lists and Patient Selection," CEPR Discussion Papers 2519, C.E.P.R. Discussion Papers.
- H. Naci Mocan & Erdal Tekin & Jeffrey S. Zax, 2000.
"The Demand for Medical Care in Urban China,"
NBER Working Papers
7673, National Bureau of Economic Research, Inc.
- Lindsay, Cotton M & Feigenbaum, Bernard, 1984. "Rationing by Waiting Lists," American Economic Review, American Economic Association, vol. 74(3), pages 404-17, June.
- Janssen, Richard, 1992. "Time prices and the demand for GP services," Social Science & Medicine, Elsevier, vol. 34(7), pages 725-733, April.
- Goldman, Fred & Grossman, Michael, 1978.
"The Demand for Pediatric Care: An Hedonic Approach,"
Journal of Political Economy,
University of Chicago Press, vol. 86(2), pages 259-80, April.
- Fred Goldman & Michael Grossman, 1979. "The Demand for Pediatric Care: An Hedonic Approach," NBER Working Papers 0134, National Bureau of Economic Research, Inc.
- Martin, Stephen & Smith, Peter C., 1999. "Rationing by waiting lists: an empirical investigation," Journal of Public Economics, Elsevier, vol. 71(1), pages 141-164, January.
- Partha Deb & Ann M. Holmes, 2000. "Estimates of use and costs of behavioural health care: a comparison of standard and finite mixture models," Health Economics, John Wiley & Sons, Ltd., vol. 9(6), pages 475-489.
- Wagstaff, Adam, 1986. "The demand for health : Some new empirical evidence," Journal of Health Economics, Elsevier, vol. 5(3), pages 195-233, September.
- Wedel, M, et al, 1993. "A Latent Class Poisson Regression Model for Heterogeneous Count Data," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 8(4), pages 397-411, Oct.-Dec..
- J.A. Goddard & M. Tavakoli, 1998. "Referral rates and waiting lists: some empirical evidence," Health Economics, John Wiley & Sons, Ltd., vol. 7(6), pages 545-549.
- Deb, Partha & Trivedi, Pravin K., 2002. "The structure of demand for health care: latent class versus two-part models," Journal of Health Economics, Elsevier, vol. 21(4), pages 601-625, July.
- Gerdtham, Ulf-G. & Trivedi, Pravin K., 2000.
"Equity in Swedish Health Care Reconsidered: New Results based on the Finite Mixture Model,"
SSE/EFI Working Paper Series in Economics and Finance
365, Stockholm School of Economics.
- Ulf-G. Gerdtham & Pravin K. Trivedi, 2001. "Equity in Swedish health care reconsidered: new results based on the finite mixture model," Health Economics, John Wiley & Sons, Ltd., vol. 10(6), pages 565-572.
- 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.
- Cullis, John G. & Jones, Philip R. & Propper, Carol, 2000. "Waiting lists and medical treatment: Analysis and policies," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 23, pages 1201-1249 Elsevier.
- Cameron, A Colin & Trivedi, Pravin K, 1986. "Econometric Models Based on Count Data: Comparisons and Applications of Some Estimators and Tests," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 1(1), pages 29-53, January.
- J. M. C. Santos Silva, 2003. "A note on the estimation of mixture models under endogenous sampling," Econometrics Journal, Royal Economic Society, vol. 6(1), pages 46-52, 06.
- Brannas, Kurt & Rosenqvist, Gunnar, 1994. "Semiparametric estimation of heterogeneous count data models," European Journal of Operational Research, Elsevier, vol. 76(2), pages 247-258, July.
- Vincenzo Atella & Francesco Brindisi & Partha Deb & Furio C. Rosati, 2004.
"Determinants of access to physician services in Italy: a latent class seemingly unrelated probit approach,"
John Wiley & Sons, Ltd., vol. 13(7), pages 657-668.
- Vincenzo Atella & Francesco Brindisi & Partha Deb & Furio C. Rosati, 2003. "Determinants of Access to Physician Services in Italy: A Latent Class Seemingly Unrelated Probit Approach," CEIS Research Paper 36, Tor Vergata University, CEIS.
- Richard Blundell & Frank Windmeijer, 2000.
"Identifying demand for health resources using waiting times information,"
IFS Working Papers
W00/03, Institute for Fiscal Studies.
- Richard Blundell & Frank Windmeijer, 2000. "Identifying demand for health resources using waiting times information," Health Economics, John Wiley & Sons, Ltd., vol. 9(6), pages 465-474.
- 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.
- Phelps, Charles E & Newhouse, Joseph P, 1974. "Coinsurance, the Price of Time, and the Demand for Medical Services," The Review of Economics and Statistics, MIT Press, vol. 56(3), pages 334-42, August.
- 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.
- Gravelle, Hugh & Dusheiko, Mark & Sutton, Matthew, 2002. "The demand for elective surgery in a public system: time and money prices in the UK National Health Service," Journal of Health Economics, Elsevier, vol. 21(3), pages 423-449, May.
- Sin, Chor-Yiu & White, Halbert, 1996. "Information criteria for selecting possibly misspecified parametric models," Journal of Econometrics, Elsevier, vol. 71(1-2), pages 207-225.
- 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.
- Deb, Partha & Trivedi, Pravin K, 1997. "Demand for Medical Care by the Elderly: A Finite Mixture Approach," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 12(3), pages 313-36, May-June.
- Grogger, J T & Carson, Richard T, 1991. "Models for Truncated Counts," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 6(3), pages 225-38, July-Sept.
- 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.
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