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Estimates of use and costs of behavioural health care: a comparison of standard and finite mixture models

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  • Partha Deb

    (Department of Economics, Indiana University-Purdue University Indianapolis, Indianapolis, USA)

  • Ann M. Holmes

    (School of Public and Environmental Affairs, Indiana University-Purdue University Indianapolis, Indianapolis, USA)

Abstract

Estimates of health care demand are known to depend on the empirical specification used in the analysis. In this paper, an innovative specification, the finite mixture model (FMM), is employed to estimate the utilization of and expenditures on behavioural health care. Unlike standard specifications, the FMM has the ability to distinguish between distinct classes of users of behavioural health care (e.g. the 'worried well' and the severely mentally ill). This new model is tested against standard empirical specifications using data from the National Medical Expenditure Survey. Using common risk stratifiers, estimates of utilization and costs are generated with each specification. It is found that the FMM provides a much better fit of both expenditure and utilization data than standard specifications, particularly among high intensity users that standard models have been unable to represent adequately. Furthermore, the results provide preliminary evidence that there are (at least) two distinct groups of users of behavioural health care. The empirical advantages of the FMM translate into superior estimates of mean costs and utilization that have widespread application in rate-setting exercises. Copyright © 2000 John Wiley & Sons, Ltd.

Suggested Citation

  • 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.
  • Handle: RePEc:wly:hlthec:v:9:y:2000:i:6:p:475-489
    DOI: 10.1002/1099-1050(200009)9:6<475::AID-HEC544>3.0.CO;2-H
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    Cited by:

    1. Alice Sanwald & Engelbert Theurl, 2016. "Out-of-pocket expenditure by private households for dental services – empirical evidence from Austria," Health Economics Review, Springer, vol. 6(1), pages 1-9, December.
    2. 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.
    3. Óscar D. Lourenço & Pedro L. Ferreira, 2005. "Utilization of public health centres in Portugal: effect of time costs and other determinants. Finite mixture models applied to truncated samples," Health Economics, John Wiley & Sons, Ltd., vol. 14(9), pages 939-953.
    4. Teresa Bago d'Uva, 2005. "Latent class models for use of primary care: evidence from a British panel," Health Economics, John Wiley & Sons, Ltd., vol. 14(9), pages 873-892.
    5. Bago d'Uva, Teresa & Jones, Andrew M. & van Doorslaer, Eddy, 2009. "Measurement of horizontal inequity in health care utilisation using European panel data," Journal of Health Economics, Elsevier, vol. 28(2), pages 280-289, March.
    6. Hendrik Schmitz, 2012. "More health care utilization with more insurance coverage? Evidence from a latent class model with German data," Applied Economics, Taylor & Francis Journals, vol. 44(34), pages 4455-4468, December.
    7. 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.
    8. Sergi Jiménez-Martín & José M. Labeaga & Maite Martínez-Granado, 2002. "Latent class versus two-part models in the demand for physician services across the European Union," Health Economics, John Wiley & Sons, Ltd., vol. 11(4), pages 301-321.
    9. 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.
    10. Michael Creel, 2002. "Hausman Tests for Inefficient Estimators: Application to Demand for Health Care Service (revised)," UFAE and IAE Working Papers 509.02, Unitat de Fonaments de l'Anàlisi Econòmica (UAB) and Institut d'Anàlisi Econòmica (CSIC).
    11. Monika Sander, 2008. "Is There Migration-Related Inequity in Access to or in the Utilisation of Health Care in Germany?," SOEPpapers on Multidisciplinary Panel Data Research 147, DIW Berlin, The German Socio-Economic Panel (SOEP).
    12. 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.
    13. Jeffrey E. Harris & Sandra G. Sosa-Rubi, 2009. "Impact of "Seguro Popular" on Prenatal Visits in Mexico, 2002-2005: Latent Class Model of Count Data with a Discrete Endogenous Variable," NBER Working Papers 14995, National Bureau of Economic Research, Inc.
    14. 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.
    15. Bago d'Uva, Teresa & Jones, Andrew M., 2009. "Health care utilisation in Europe: New evidence from the ECHP," Journal of Health Economics, Elsevier, vol. 28(2), pages 265-279, March.
    16. Óscar Lourenço & Carlota Quintal & Pedro Lopes Ferreira & Pedro Pita Barros, 2007. "A equidade na utilização de cuidados de saúde em Portugal: Uma avaliação baseada em modelos de contagem," Notas Económicas, Faculty of Economics, University of Coimbra, issue 25, pages 6-26, June.
    17. Alice Sanwald & Engelbert Theurl, 2015. "Out-of-pocket expenditures for pharmaceuticals: Lessons from the Austrian household budget survey," Working Papers 2015-01, Faculty of Economics and Statistics, University of Innsbruck.
    18. Jones, A.M, 2010. "Models For Health Care," Health, Econometrics and Data Group (HEDG) Working Papers 10/01, HEDG, c/o Department of Economics, University of York.
    19. repec:ris:apltrx:0315 is not listed on IDEAS
    20. repec:eee:touman:v:32:y:2011:i:3:p:555-563 is not listed on IDEAS
    21. 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.
    22. Stefan Meyer, 2016. "Dispensing physicians, asymmetric information supplier-induced demand: evidence from the Swiss Health Survey," International Journal of Health Economics and Management, Springer, vol. 16(3), pages 215-245, September.

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