Health care provider choice in the case of patient-initiated contacts. An extended version of discrete choice of model demand
This paper analyzes the nature of health care provider choice in the case of patient-initiated contacts, with special reference to a National Health Service setting, where monetary prices are zero and general practitioners act as gatekeepers to publicly financed specialized care. We focus our attention on the factors that may explain the continuously increasing use of hospital emergency visits as opposed to other provider alternatives. An extended version of a discrete choice model of demand for patient-initiated contacts is presented, allowing for individual and town residence size differences in perceived quality (preferences) between alternative providers and including travel and waiting time as non-monetary costs. Results of a nested multinomial logit model of provider choice are presented. Individual choice between alternatives considers, in a repeated nested structure, self-care, primary care, hospital and clinic emergency services. Welfare implications and income effects are analyzed by computing compensating variations, and by simulating the effects of user fees by levels of income. Results indicate that compensating variation per visit is higher than the direct marginal cost of emergency visits, and consequently, emergency visits do not appear as an inefficient alternative even for non-urgent conditions.
References listed on IDEAS
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-277, June.
- 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.
- Ann D. Colle & Michael Grossman, 1979. "Determinants of Pediatric Care Utilization," NBER Working Papers 0240, National Bureau of Economic Research, Inc.
- Hausman, Jerry & McFadden, Daniel, 1984.
"Specification Tests for the Multinomial Logit Model,"
Econometric Society, vol. 52(5), pages 1219-1240, September.
- D. McFadden & J. Hausman, 1981. "Specification Tests for the Multinominal Logit Model," Working papers 292, Massachusetts Institute of Technology (MIT), Department of Economics.
- Gertler, Paul & Locay, Luis & Sanderson, Warren, 1987.
"Are user fees regressive? : The welfare implications of health care financing proposals in Peru,"
Journal of Econometrics,
Elsevier, vol. 36(1-2), pages 67-88.
- Paul J. Gertler & Luis Locay & Warren C. Sanderson, 1987. "Are User Fees Regressive? The Welfare Implications of Health Care Financing Proposals in Peru," NBER Working Papers 2299, National Bureau of Economic Research, Inc.
- Stephen Birch & John Eyles & K. Bruce Newbold, 1993.
"Equitable access to health care: Methodological extensions to the analysis of physician utilization in Canada,"
John Wiley & Sons, Ltd., vol. 2(2), pages 87-101, July.
- S Birch & J Eyles & KM Newbold, 1993. "Equitable Access to Health Care: Methodological Extensions to the Analysis of Physician Utilization in Canada," Centre for Health Economics and Policy Analysis Working Paper Series 1993-03, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
- Borsch-Supan, Axel, 1990. "On the compatibility of nested logit models with utility maximization," Journal of Econometrics, Elsevier, vol. 43(3), pages 373-388, March.
- Roger Feldman & Michael Finch & Bryan Dowd & Steven Cassou, 1989. "The Demand for Employment-Based Health Insurance Plans," Journal of Human Resources, University of Wisconsin Press, vol. 24(1), pages 115-142.
- Vistnes, Jessica Primoff & Hamilton, Vivian, 1995. "The Time and Monetary Costs of Outpatient Care for Children," American Economic Review, American Economic Association, vol. 85(2), pages 117-121, May.
- 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.
- BOLDUC, Denis & LACROIX, Guy & MULLER, Christophe, 1994. "The Choice of Medical Providers in Rural Bénin: a Comparison of Discrete Choice Model," Cahiers de recherche 9411, Université Laval - Département d'économique.
- 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.
- Germano Mwabu & Martha Ainsworth & Andrew Nyamete, 1993. "Quality of Medical Care and Choice of Medical Treatment in Kenya: An Empirical Analysis," Journal of Human Resources, University of Wisconsin Press, vol. 28(4), pages 838-862.
- Kling, Catherine L. & Thomson, Cynthia J., 1996. "Implications of Model Specification for Welfare Estimation in Nested Logit Models (The)," Staff General Research Papers Archive 1599, Iowa State University, Department of Economics.
- Randall P. Ellis & D. Keith McInnes & Elizabeth H. Stephenson, 1994. "Inpatient and outpatient health care demand in Cairo, Egypt," Health Economics, John Wiley & Sons, Ltd., vol. 3(3), pages 183-200, May.
- J L Horowitz, 1987. "Specification Tests for Nested Logit Models," Environment and Planning A, , vol. 19(3), pages 395-402, March.
- 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.
- Trajtenberg, Manuel, 1989. "The Welfare Analysis of Product Innovations, with an Application to Computed Tomography Scanners," Journal of Political Economy, University of Chicago Press, vol. 97(2), pages 444-479, April.
- Cauley, Stephen Day, 1987. "The Time Price of Medical Care," The Review of Economics and Statistics, MIT Press, vol. 69(1), pages 59-66, February.
- Dor, Avi & Gertler, Paul & van der Gaag, Jacques, 1987. "Non-price rationing and the choice of medical care providers in rural Cote d'Ivoire," Journal of Health Economics, Elsevier, vol. 6(4), pages 291-304, December.
- A. C. Cameron & P. K. Trivedi & Frank Milne & J. Piggott, 1988. "A Microeconometric Model of the Demand for Health Care and Health Insurance in Australia," Review of Economic Studies, Oxford University Press, vol. 55(1), pages 85-106.
- Koning, Ruud H. & Ridder, Geert, 1994. "On the compatibility of nested logit models with utility maximization : A comment," Journal of Econometrics, Elsevier, vol. 63(2), pages 389-396, August.
- Wedig, Gerard J., 1988. "Health status and the demand for health : Results on price elasticities," Journal of Health Economics, Elsevier, vol. 7(2), pages 151-163, June.
- Van de Ven, Wynand P. M. M. & Van Der Gaag, Jacques, 1982. "Health as an unobservable : A MIMIC-model of demand for health care," Journal of Health Economics, Elsevier, vol. 1(2), pages 157-183, August.
When requesting a correction, please mention this item's handle: RePEc:upf:upfgen:308. See general information about how to correct material in RePEc.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: ()
If references are entirely missing, you can add them using this form.