IDEAS home Printed from https://ideas.repec.org/a/wly/hlthec/v24y2015i9p1131-1146.html
   My bibliography  Save this article

Effects of Geographical Accessibility on the Use of Outpatient Care Services: Quasi‐Experimental Evidence from Panel Count Data

Author

Listed:
  • Péter Elek
  • Balázs Váradi
  • Márton Varga

Abstract

In 2010–2012, new outpatient service locations were established in Hungarian micro‐regions, which had lacked such capacities before. We exploit this quasi‐experiment to estimate the effect of geographical accessibility on outpatient case numbers using both individual‐level and semi‐aggregate panel data. We find a 24–27 per cent increase of case numbers as a result of the establishments. Our specialty‐by‐specialty estimates imply that a 1‐min reduction of travel time to the nearest outpatient unit increases case numbers for example by 0.9 per cent in internal care and 3.1 per cent in rheumatology. The size of the new outpatient capacities has a separate effect, raising the possibility of the presence of supplier‐induced demand. By combining a fixed‐effects logit and a fixed‐effects truncated Poisson estimator, we decompose the effects into increases in the probability of ever visiting a doctor on the one hand and an increase of the frequency of visits on the other hand. We find that new visits were dominant in the vast majority of specialties, whereas both margins were important for example in rheumatology. Finally, we demonstrate the usefulness of the fixed‐effects truncated Poisson estimator in modelling count data by examining its robustness by simulations. Copyright © 2015 John Wiley & Sons, Ltd.

Suggested Citation

  • Péter Elek & Balázs Váradi & Márton Varga, 2015. "Effects of Geographical Accessibility on the Use of Outpatient Care Services: Quasi‐Experimental Evidence from Panel Count Data," Health Economics, John Wiley & Sons, Ltd., vol. 24(9), pages 1131-1146, September.
  • Handle: RePEc:wly:hlthec:v:24:y:2015:i:9:p:1131-1146
    DOI: 10.1002/hec.3201
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/hec.3201
    Download Restriction: no

    File URL: https://libkey.io/10.1002/hec.3201?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. Richard K. Crump & V. Joseph Hotz & Guido W. Imbens & Oscar A. Mitnik, 2009. "Dealing with limited overlap in estimation of average treatment effects," Biometrika, Biometrika Trust, vol. 96(1), pages 187-199.
    2. Wooldridge, Jeffrey M., 1999. "Distribution-free estimation of some nonlinear panel data models," Journal of Econometrics, Elsevier, vol. 90(1), pages 77-97, May.
    3. Andrew M. Jones, 2009. "Panel Data Methods and Applications to Health Economics," Palgrave Macmillan Books, in: Terence C. Mills & Kerry Patterson (ed.), Palgrave Handbook of Econometrics, chapter 12, pages 557-631, Palgrave Macmillan.
    4. Erlyana, Erlyana & Damrongplasit, Kannika Kampanya & Melnick, Glenn, 2011. "Expanding health insurance to increase health care utilization: Will it have different effects in rural vs. urban areas?," Health Policy, Elsevier, vol. 100(2-3), pages 273-281, May.
    5. 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.
    6. Rainer Winkelmann, 2004. "Health care reform and the number of doctor visits-an econometric analysis," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 19(4), pages 455-472.
    7. Deb Partha & Trivedi Pravin K., 2013. "Finite Mixture for Panels with Fixed Effects," Journal of Econometric Methods, De Gruyter, vol. 2(1), pages 35-51, July.
    8. Jeffrey M Wooldridge, 2010. "Econometric Analysis of Cross Section and Panel Data," MIT Press Books, The MIT Press, edition 2, volume 1, number 0262232588, December.
    9. Majo, M.C. & van Soest, A.H.O., 2011. "The Fixed-Effects Zero-Inflated Poisson Model with an Application to Health Care Utilization," Discussion Paper 2011-083, Tilburg University, Center for Economic Research.
    10. Haynes, R. M. & Bentham, C. G., 1982. "The effects of accessibility on general practitioner consultations, out-patient attendances and in-patient admissions in Norfolk, England," Social Science & Medicine, Elsevier, vol. 16(5), pages 561-569, January.
    11. 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.
    12. 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.
    13. Joshua D. Angrist & Jörn-Steffen Pischke, 2009. "Mostly Harmless Econometrics: An Empiricist's Companion," Economics Books, Princeton University Press, edition 1, number 8769.
    14. Avdic, D., 2014. "A matter of life and death? Hospital distance and quality of care: Evidence from emergency room closures and myocardial infarctions," Health, Econometrics and Data Group (HEDG) Working Papers 14/18, HEDG, c/o Department of Economics, University of York.
    15. 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.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Péter Elek & Anita Győrfi & Nóra Kungl & Dániel Prinz, 2023. "Geographic and Socioeconomic Variation in Healthcare: Evidence from Migration," CERS-IE WORKING PAPERS 2318, Institute of Economics, Centre for Economic and Regional Studies.
    2. Tamás Hajdu & Gábor Kertesi & Gábor Kézdi & Ágnes Szabó-Morvai, 2020. "The Effects of Expanding a Neonatal Intensive Care System on Infant Mortality and Long-Term Health Impairments," CERS-IE WORKING PAPERS 2020, Institute of Economics, Centre for Economic and Regional Studies.
    3. Bíró, Anikó & Elek, Péter, 2020. "Job loss, disability insurance and health expenditure," Labour Economics, Elsevier, vol. 65(C).
    4. Bíró, Anikó & Prinz, Dániel, 2020. "Healthcare spending inequality: Evidence from Hungarian administrative data," Health Policy, Elsevier, vol. 124(3), pages 282-290.
    5. Péter Elek & Tamás Molnár & Balázs Váradi, 2019. "The closer the better: does better access to outpatient care prevent hospitalization?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(6), pages 801-817, August.
    6. Aniko Biro & Peter Elek, 2018. "Primary care availability affects antibiotic consumption – Evidence using unfilled positions in Hungary," CERS-IE WORKING PAPERS 1810, Institute of Economics, Centre for Economic and Regional Studies.
    7. Armin Lucevic & Márta Péntek & Dionne Kringos & Niek Klazinga & László Gulácsi & Óscar Brito Fernandes & Imre Boncz & Petra Baji, 2019. "Unmet medical needs in ambulatory care in Hungary: forgone visits and medications from a representative population survey," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(1), pages 71-78, June.
    8. Anikó Bíró & Péter Elek, 2018. "How does retirement affect healthcare expenditures? Evidence from a change in the retirement age," Health Economics, John Wiley & Sons, Ltd., vol. 27(5), pages 803-818, May.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Elek, P. & Varadi, B. & Varga, M., 2014. "Effects of geographical accessibility on the use of outpatient care services: quasi-experimental evidence from administrative panel data," Health, Econometrics and Data Group (HEDG) Working Papers 14/17, HEDG, c/o Department of Economics, University of York.
    2. Czarnitzki, Dirk & Doherr, Thorsten & Hussinger, Katrin & Schliessler, Paula & Toole, Andrew A., 2016. "Knowledge Creates Markets: The influence of entrepreneurial support and patent rights on academic entrepreneurship," European Economic Review, Elsevier, vol. 86(C), pages 131-146.
    3. Hudson, Eibhlin & Nolan, Anne, 2015. "Public healthcare eligibility and the utilisation of GP services by older people in Ireland," The Journal of the Economics of Ageing, Elsevier, vol. 6(C), pages 24-43.
    4. Teresa Bago d'Uva, 2006. "Latent class models for utilisation of health care," Health Economics, John Wiley & Sons, Ltd., vol. 15(4), pages 329-343, April.
    5. Majo, M.C., 2010. "A microeconometric analysis of health care utilization in Europe," Other publications TiSEM 1cf5fd2f-8146-4ef8-8eb5-e, Tilburg University, School of Economics and Management.
    6. Graham, Bryan S. & Pinto, Cristine Campos de Xavier, 2022. "Semiparametrically efficient estimation of the average linear regression function," Journal of Econometrics, Elsevier, vol. 226(1), pages 115-138.
    7. Christopher J. Cronin & David K. Guilkey & Ilene S. Speizer, 2019. "Measurement error in discrete health facility choice models: An example from urban Senegal," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 34(7), pages 1102-1120, November.
    8. 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.
    9. Moreira S & Pita Barros P, 2009. "Double coverage and demand for health care: Evidence from quantile regression," Health, Econometrics and Data Group (HEDG) Working Papers 09/21, HEDG, c/o Department of Economics, University of York.
    10. Erik Schokkaert & Tom Van Ourti & Diana De Graeve & Ann Lecluyse & Carine Van de Voorde, 2010. "Supplemental health insurance and equality of access in Belgium," Health Economics, John Wiley & Sons, Ltd., vol. 19(4), pages 377-395, April.
    11. Sergi Jiménez-Martín & José Labeaga & Maite Martínez-Granado, 2004. "An empirical analysis of the demand for physician services across the European Union," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 5(2), pages 150-165, May.
    12. Batkeyev, Birzhan & DeRemer, David R., 2023. "Mountains of evidence: The effects of abnormal air pollution on crime," Journal of Economic Behavior & Organization, Elsevier, vol. 210(C), pages 288-319.
    13. Vladimir Atanasov & Bernard Black, 2021. "The Trouble with Instruments: The Need for Pretreatment Balance in Shock-Based Instrumental Variable Designs," Management Science, INFORMS, vol. 67(2), pages 1270-1302, February.
    14. BURNEY, Nadeem A. & ALENEZI, Mohammad & HAMADA, Salwa & AL-MUSALLAM, Nadia, 2019. "The Demand for Public and Private Medical Care Services: Evidence from Kuwait," Economia Internazionale / International Economics, Camera di Commercio Industria Artigianato Agricoltura di Genova, vol. 72(1), pages 107-138.
    15. Yong-Woo Lee, 2013. "Testing for the Presence of Moral Hazard Using the Regulatory Reform in the Car Insurance Market: Case of Korea," The Japanese Economic Review, Japanese Economic Association, vol. 64(3), pages 414-429, September.
    16. Benjamin Bittschi & Sarah Borgloh & Berthold U. Wigger, 2020. "Philanthropy in a Secular Society," Journal of Institutional and Theoretical Economics (JITE), Mohr Siebeck, Tübingen, vol. 176(4), pages 640-664.
    17. Majo, M.C. & van Soest, A.H.O., 2011. "The Fixed-Effects Zero-Inflated Poisson Model with an Application to Health Care Utilization," Other publications TiSEM 68cf0f9b-fc68-4017-97a9-a, Tilburg University, School of Economics and Management.
    18. Fabbri, Daniele & Monfardini, Chiara, 2009. "Rationing the public provision of healthcare in the presence of private supplements: Evidence from the Italian NHS," Journal of Health Economics, Elsevier, vol. 28(2), pages 290-304, March.
    19. Galina Besstremyannaya, 2014. "Heterogeneous effect of coinsurance rate on healthcare costs: generalized finite mixtures and matching estimators," Discussion Papers 14-014, Stanford Institute for Economic Policy Research.
    20. Anders Skrondal & Sophia Rabe-Hesketh, 2022. "The Role of Conditional Likelihoods in Latent Variable Modeling," Psychometrika, Springer;The Psychometric Society, vol. 87(3), pages 799-834, September.

    More about this item

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • C23 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Models with Panel Data; Spatio-temporal Models
    • C25 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Discrete Regression and Qualitative Choice Models; Discrete Regressors; Proportions; Probabilities

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:wly:hlthec:v:24:y:2015:i:9:p:1131-1146. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: http://www3.interscience.wiley.com/cgi-bin/jhome/5749 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.