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Evaluating the Impact of Eligibility for Free Care on the Use of GP Services in Ireland: A Difference-in-Difference Matching Approach

  • Nolan, Anne

    (Economic and Social Research Institute (ESRI))

In Ireland, approximately 30 per cent of the population (“medical card patients”) are entitled to free GP care while the remaining 70 per cent (“private patients”) must pay the full cost of each visit. While previous research has analysed the effect of this system on GP visiting patterns using regression methods, to date, no attempt has been made to apply techniques from the treatment evaluation literature to this issue. Treatment evaluation techniques are commonly employed when observations are not randomly assigned to treatment and control groups; this is certainly the case here, as the primary criterion for medical card eligibility is an income below a specified income threshold (and individuals may also be granted medical cards for other reasons such as chronic ill-health). In this paper, we extend previous Irish research, which has analysed the effect of medical card eligibility on GP visiting using regression methods, to consider the use of difference-in-difference matching methods, which allow us to control for non-random selection into treatment and control groups, as well as unobserved differences in characteristics between individuals in both groups. The results are largely consistent with earlier results using pooled cross-sectional and panel data, and confirm that medical card eligibility exerts a significant effect on GP visiting, even after controlling for observed and unobserved differences in characteristics between medical card and private patients.

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Paper provided by Economic and Social Research Institute (ESRI) in its series Papers with number HRBWP25.

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Length: 27 pages
Date of creation: Oct 2006
Date of revision:
Handle: RePEc:esr:wpaper:hrb25
Note: Published by ESRI, ISSC & University of Ulster
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  1. Madden, David & Nolan, Anne & Nolan, Brian, 2004. "GP Reimbursement and Visiting Behaviour in Ireland," Papers HRBWP09, Economic and Social Research Institute (ESRI).
  2. Rajeev H. Dehejia & Sadek Wahba, 1998. "Causal Effects in Non-Experimental Studies: Re-Evaluating the Evaluation of Training Programs," NBER Working Papers 6586, National Bureau of Economic Research, Inc.
  3. A. Nolan & B. Nolan, 2008. "Eligibility for free GP care, “need” and GP visiting in Ireland," The European Journal of Health Economics, Springer, vol. 9(2), pages 157-163, May.
  4. Lechner, Michael & Vazquez-Alvarez, Rosalia, 2004. "The Effect of Disability on Labour Market Outcomes in Germany: Evidence from Matching," CEPR Discussion Papers 4223, C.E.P.R. Discussion Papers.
  5. Arnstein Aassve & Gianni Betti & Stefano Mazzuco & Letizia Mencarini, 2007. "Marital disruption and economic well-being: a comparative analysis," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 170(3), pages 781-799.
  6. Anne Nolan, 2007. "A dynamic analysis of GP visiting in Ireland: 1995-2001," Health Economics, John Wiley & Sons, Ltd., vol. 16(2), pages 129-143.
  7. Holger Görg & Eric Strobl, 2006. "Do Government Subsidies Stimulate Training Expenditure? Microeconometric Evidence from Plant-Level Data," Southern Economic Journal, Southern Economic Association, vol. 72(4), pages 860–876, April.
  8. LaLonde, Robert J, 1986. "Evaluating the Econometric Evaluations of Training Programs with Experimental Data," American Economic Review, American Economic Association, vol. 76(4), pages 604-20, September.
  9. Sascha O. Becker & Andrea Ichino, 2002. "Estimation of average treatment effects based on propensity scores," Stata Journal, StataCorp LP, vol. 2(4), pages 358-377, November.
  10. Nolan, Brian, 1993. "Economic incentives, health status and health services utilisation," Journal of Health Economics, Elsevier, vol. 12(2), pages 151-169, July.
  11. Heckman, James J & Ichimura, Hidehiko & Todd, Petra, 1998. "Matching as an Econometric Evaluation Estimator," Review of Economic Studies, Wiley Blackwell, vol. 65(2), pages 261-94, April.
  12. Pilar García Gómez & Angel López Nicolás, 2005. "Health shocks, employment and income in the Spanish labour markets," Health, Econometrics and Data Group (HEDG) Working Papers 05/14, HEDG, c/o Department of Economics, University of York.
  13. Richard Blundell & Monica Costa Dias, 2000. "Evaluation methods for non-experimental data," Fiscal Studies, Institute for Fiscal Studies, vol. 21(4), pages 427-468, January.
  14. Nolan, Brian, 1991. "The Utilisation and Financing of Health Services in Ireland," Research Series, Economic and Social Research Institute (ESRI), number GRS155.
  15. Denis Conniffe & Vanessa Gash & Philip J. O'Connell, 2000. "Evaluating State Programmes - “Natural Experiments” and Propensity Scores," The Economic and Social Review, Economic and Social Studies, vol. 31(4), pages 283-308.
  16. Antonio Trujillo & Jorge Portillo & John Vernon, 2005. "The Impact of Subsidized Health Insurance for the Poor: Evaluating the Colombian Experience Using Propensity Score Matching," International Journal of Health Care Finance and Economics, Springer, vol. 5(3), pages 211-239, September.
  17. Alex Bryson & Richard Dorsett & Susan Purdon, 2002. "The use of propensity score matching in the evaluation of active labour market policies," LSE Research Online Documents on Economics 4993, London School of Economics and Political Science, LSE Library.
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