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Inequity in Publicly Funded Physician Care: What Is The Role Of Private Prescription Drug Insurance?

Author

Listed:
  • Sara Allin

    () (LSE Health, London School of Economics and Political Science)

  • Jeremiah Hurley

    () (Department of Economics and Centre for Health Economics and Policy Analysis, McMaster University)

Abstract

This study examines the impact that private financing of prescription drugs in Canada has on equity in the utilization of publicly financed physician services. The complementary nature of prescription drugs and physician service use alongside the reliance on private finance for drugs may induce an income gradient in the use of physicians. We use established econometric methods based on concentration curves to measure equity in physician utilization and its contributors in the province of Ontario. We find that individuals with prescription drug insurance make more physician visits than do those without insurance, and the effect on utilization is stronger for the likelihood of a visit than the conditional number of visits, and for individuals with no chronic conditions than those with at least one condition. Results of the equity analyses reveal the most important contributors to the pro-rich inequity in physician utilization are income and private insurance, while public insurance, which covers older people and those on social assistance, has a pro-poor effect. These findings highlight that inequity in access to and use of publicly funded services may arise from the interaction with privately financed health services that are complements to the use of public services.

Suggested Citation

  • Sara Allin & Jeremiah Hurley, 2008. "Inequity in Publicly Funded Physician Care: What Is The Role Of Private Prescription Drug Insurance?," Centre for Health Economics and Policy Analysis Working Paper Series 2008-02, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
  • Handle: RePEc:hpa:wpaper:200802
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    References listed on IDEAS

    as
    1. Kapur, Vishnu & Basu, Kisalaya, 2005. "Drug coverage in Canada: who is at risk?," Health Policy, Elsevier, vol. 71(2), pages 181-193, February.
    2. Thomas C. Buchmueller & Agnès Couffinhal & Michel Grignon & Marc Perronnin, 2004. "Access to physician services: does supplemental insurance matter? Evidence from France," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 669-687.
    3. Lori J. Curtis & William J. MacMinn, 2007. "Health-Care Utilization in Canada: 25 Years of Evidence," Social and Economic Dimensions of an Aging Population Research Papers 190, McMaster University.
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    5. Baoping Shang & Dana P. Goldman, 2007. "Prescription Drug Coverage and Elderly Medicare Spending," NBER Working Papers 13358, National Bureau of Economic Research, Inc.
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    7. Amitabh Chandra & Jonathan Gruber & Robin McKnight, 2007. "Patient Cost-Sharing, Hospitalization Offsets, and the Design of Optimal Health Insurance for the Elderly," NBER Working Papers 12972, National Bureau of Economic Research, Inc.
    8. 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 223-255, March-Apr.
    9. Jeremiah Hurley & Emmanuel Guindon, 2008. "Private Health Insurance in Canada," Centre for Health Economics and Policy Analysis Working Paper Series 2008-04, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
    10. Wagstaff, Adam & van Doorslaer, Eddy & Paci, Pierella, 1991. "On the measurement of horizontal inequity in the delivery of health care," Journal of Health Economics, Elsevier, vol. 10(2), pages 169-205, July.
    11. repec:mpr:mprres:2479 is not listed on IDEAS
    12. Dolores Jiménez-Rubio & Peter C. Smith & Eddy Van Doorslaer, 2008. "Equity in health and health care in a decentralised context: evidence from Canada," Health Economics, John Wiley & Sons, Ltd., vol. 17(3), pages 377-392.
    13. Kakwani, Nanak & Wagstaff, Adam & van Doorslaer, Eddy, 1997. "Socioeconomic inequalities in health: Measurement, computation, and statistical inference," Journal of Econometrics, Elsevier, vol. 77(1), pages 87-103, March.
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    Citations

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    Cited by:

    1. Felipe Vásquez & Alejandra Chovar & Guillermo Paraje, 2011. "Desigualdad e inequidad en la utilización de servicios médicos por grupos etarios en Chile, 2000-2011," Past Working Papers 11, Universidad del Desarrollo, School of Business and Economics, revised 2015.
    2. Richard Layte & Anne Nolan, 2015. "Eligibility for free GP care and the utilisation of GP services by children in Ireland," International Journal of Health Economics and Management, Springer, vol. 15(1), pages 3-27, March.
    3. Allin, Sara & Law, Michael R. & Laporte, Audrey, 2013. "How does complementary private prescription drug insurance coverage affect seniors’ use of publicly funded medications?," Health Policy, Elsevier, vol. 110(2), pages 147-155.
    4. Nolan, Anne & Layte, Richard, 2017. "The impact of transitions in insurance coverage on GP visiting among children in Ireland," Social Science & Medicine, Elsevier, vol. 180(C), pages 94-100.
    5. Wang, Chao & Li, Qing & Sweetman, Arthur & Hurley, Jeremiah, 2015. "Mandatory universal drug plan, access to health care and health: Evidence from Canada," Journal of Health Economics, Elsevier, vol. 44(C), pages 80-96.
    6. Devlin, Rose Anne & Sarma, Sisira & Zhang, Qi, 2011. "The role of supplemental coverage in a universal health insurance system: Some Canadian evidence," Health Policy, Elsevier, vol. 100(1), pages 81-90, April.
    7. Nolan, Anne & Smith, Samantha, 2012. "The effect of differential eligibility for free GP services on GP utilisation in Ireland," Social Science & Medicine, Elsevier, vol. 74(10), pages 1644-1651.
    8. repec:spr:eujhec:v:19:y:2018:i:3:d:10.1007_s10198-017-0889-3 is not listed on IDEAS
    9. repec:eee:joecag:v:6:y:2015:i:c:p:24-43 is not listed on IDEAS
    10. repec:eee:hepoli:v:121:y:2017:i:11:p:1177-1185 is not listed on IDEAS
    11. Jeremiah Hurley & Emmanuel Guindon, 2008. "Private Health Insurance in Canada," Centre for Health Economics and Policy Analysis Working Paper Series 2008-04, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.

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    Keywords

    equity; private insurance; prescription drugs; physician utilization;

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