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Are bad health and pain making us grumpy? An empirical evaluation of reporting heterogeneity in rating health system responsiveness

  • G. Fiorentini
  • G. Ragazzi
  • S. Robone

This paper considers the influence of patients’ characteristics on their evaluation of a health system’s responsiveness, that is, a system’s ability to respond to the legitimate expectations of potential users regarding non-health enhancing aspects of care (Valentine et al. 2003a). Since responsiveness is evaluated by patients on a categorical scale, their selfevaluation can be affected by the phenomenon of reporting heterogeneity (Rice et al. 2012). A few studies have investigated how standard socio-demographic characteristics influence the reporting style of health care users with regard to the question of the health system’s responsiveness (Sirven et al. 2012, Rice et al. 2012). However, we are not aware of any studies that focus explicitly on the influence that both the patients’ state of health and their experiencing of pain have on the way in which they report on system responsiveness. This paper tries to bridge this gap by using data regarding a sample of patients hospitalized in four Local Health Authorities (LHA) in Italy’s Emilia-Romagna region between 2010 and 2012. These patients have evaluated 27 different aspects of the quality of care, concerning five domains of responsiveness (communication, social support, privacy, dignity and quality of facilities). Data have been stratified into five sub-samples, according to these domains. We estimate a generalized ordered probit model (Terza, 1985), an extension of the standard ordered probit model which permits the reporting behaviour of respondents to be modelled as a function of certain respondents’ characteristics, which in our analysis are represented by the variables “state of health” and “pain”. Our results suggest that unhealthier patients are more likely to report a lower level of responsiveness, all other things being equal, while patients experiencing pain are more likely to make use of the extreme categories of responsiveness, that is, to choose the category “completely dissatisfied” or the category “completely satisfied”. These results hold across all five domains of responsiveness.

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Paper provided by Dipartimento Scienze Economiche, Universita' di Bologna in its series Working Papers with number wp933.

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Date of creation: Mar 2014
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Handle: RePEc:bol:bodewp:wp933
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  1. Stephen Pudney & Michael Shields, . "Gender, Race, Pay and Promotion in the British Nursing Profession: Estimation of a Generalised Ordered Probit Model," Discussion Papers in Public Sector Economics 97/4, Department of Economics, University of Leicester.
  2. Teresa Bago d'Uva & Eddy Van Doorslaer & Maarten Lindeboom & Owen O'Donnell, 2008. "Does reporting heterogeneity bias the measurement of health disparities?," Health Economics, John Wiley & Sons, Ltd., vol. 17(3), pages 351-375.
  3. Nicolas Sirven & Brigitte Santos-Eggimann & Jacques Spagnoli, 2012. "Comparability of Health Care Responsiveness in Europe," Social Indicators Research, Springer, vol. 105(2), pages 255-271, January.
  4. Janoes, A; & Rice, N; & Robone, S; & Rosa Dias, P;, 2010. "Inequality and Polarisation in Health Systems’ Responsiveness: A Cross-Country Analysis," Health, Econometrics and Data Group (HEDG) Working Papers 10/27, HEDG, c/o Department of Economics, University of York.
  5. Nigel Rice & Silvana Robone & Peter Smith, 2009. "Vignettes and health systems responsiveness in crosscountry comparative analyses," Health, Econometrics and Data Group (HEDG) Working Papers 09/29, HEDG, c/o Department of Economics, University of York.
  6. Rice, N & Robone, S & Smith, P.C, 2008. "International Comparison of Public Sector Performance: The Use of Anchoring Vignettes to adjust Self-Reported Data," Health, Econometrics and Data Group (HEDG) Working Papers 08/28, HEDG, c/o Department of Economics, University of York.
  7. Robone, S; & Rice, N; & Smith, P;, 2010. "Health systems’ responsiveness and its characteristics: a cross-country comparative analysis," Health, Econometrics and Data Group (HEDG) Working Papers 10/29, HEDG, c/o Department of Economics, University of York.
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