IDEAS home Printed from https://ideas.repec.org/p/yor/hectdg/14-17.html
   My bibliography  Save this paper

Effects of geographical accessibility on the use of outpatient care services: quasi-experimental evidence from administrative panel data

Author

Listed:
  • Elek, P.
  • Varadi, B.
  • Varga, M.

Abstract

Between 2008 and 2012 new outpatient service locations were established in Hungarian micro-regions, which had lacked outpatient capacities before. We exploit this quasiexperiment to estimate the effect of geographical accessibility on outpatient case numbers using both semi-aggregate and individual-level panel data from administrative sources. Based on propensity score matching methods, fixed-effect linear models and fixed-effect Poisson regression techniques, we find a substantial, 24-28 per cent increase of case numbers as a result of the establishments. Our causal estimates imply that a one-minute reduction of travel time to the nearest outpatient care provider increases case numbers e.g. by 0.8 per cent in internal medicine and 2.8 per cent in rheumatology. We also find that the size of the new outpatient capacities has a separate positive effect on case numbers, possibly caused by supplier-induced demand. By combining a fixed effect logit model and a fixed effect truncated Poisson model, we decompose the effects into increases in the probability of ever visiting a doctor on the one hand and an increase of the frequency of visits on the other. We find that new visits were the main source of the increase in internal care, surgery and gynaecology, whereas both margins wereimportant in rheumatology. Finally, as a methodological note, we examine the robustness of the fixed effect truncated Poisson estimator to some forms of misspecification by simulation methods.

Suggested Citation

  • Elek, P. & Varadi, B. & Varga, M., 2014. "Effects of geographical accessibility on the use of outpatient care services: quasi-experimental evidence from administrative panel data," Health, Econometrics and Data Group (HEDG) Working Papers 14/17, HEDG, c/o Department of Economics, University of York.
  • Handle: RePEc:yor:hectdg:14/17
    as

    Download full text from publisher

    File URL: https://www.york.ac.uk/media/economics/documents/hedg/workingpapers/1417.pdf
    File Function: Main text
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Richard K. Crump & V. Joseph Hotz & Guido W. Imbens & Oscar A. Mitnik, 2009. "Dealing with limited overlap in estimation of average treatment effects," Biometrika, Biometrika Trust, vol. 96(1), pages 187-199.
    2. Haynes, Robin & Bentham, Graham & Lovett, Andrew & Gale, Susan, 1999. "Effects of distances to hospital and GP surgery on hospital inpatient episodes, controlling for needs and provision," Social Science & Medicine, Elsevier, vol. 49(3), pages 425-433, August.
    3. Richard Blundell & Monica Costa Dias, 2009. "Alternative Approaches to Evaluation in Empirical Microeconomics," Journal of Human Resources, University of Wisconsin Press, vol. 44(3).
    4. 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.
    5. Haynes, R. M. & Bentham, C. G., 1982. "The effects of accessibility on general practitioner consultations, out-patient attendances and in-patient admissions in Norfolk, England," Social Science & Medicine, Elsevier, vol. 16(5), pages 561-569, January.
    6. Deb, Partha & Trivedi, Pravin K., 2002. "The structure of demand for health care: latent class versus two-part models," Journal of Health Economics, Elsevier, vol. 21(4), pages 601-625, July.
    7. Hausman, Jerry & Hall, Bronwyn H & Griliches, Zvi, 1984. "Econometric Models for Count Data with an Application to the Patents-R&D Relationship," Econometrica, Econometric Society, vol. 52(4), pages 909-938, July.
    8. 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.
    9. Erlyana, Erlyana & Damrongplasit, Kannika Kampanya & Melnick, Glenn, 2011. "Expanding health insurance to increase health care utilization: Will it have different effects in rural vs. urban areas?," Health Policy, Elsevier, vol. 100(2), pages 273-281.
    10. Daniel B. Hall, 2000. "Zero-Inflated Poisson and Binomial Regression with Random Effects: A Case Study," Biometrics, The International Biometric Society, vol. 56(4), pages 1030-1039, December.
    11. 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.
    12. Wooldridge, Jeffrey M., 1999. "Distribution-free estimation of some nonlinear panel data models," Journal of Econometrics, Elsevier, vol. 90(1), pages 77-97, May.
    13. Jeffrey M Wooldridge, 2010. "Econometric Analysis of Cross Section and Panel Data," MIT Press Books, The MIT Press, edition 2, volume 1, number 0262232588, December.
    14. Alberto Abadie & Guido W. Imbens, 2008. "On the Failure of the Bootstrap for Matching Estimators," Econometrica, Econometric Society, vol. 76(6), pages 1537-1557, November.
    15. Cameron,A. Colin & Trivedi,Pravin K., 2005. "Microeconometrics," Cambridge Books, Cambridge University Press, number 9780521848053, July.
    16. 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.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Peter Elek & Balazs Varadi & Marton Varga, 2015. "Effects of geographical accessibility on the use of outpatient care services: quasi-experimental evidence from panel count data," CERS-IE WORKING PAPERS 1518, Institute of Economics, Centre for Economic and Regional Studies.
    2. Péter Elek & Balázs Váradi & Márton Varga, 2015. "Effects of Geographical Accessibility on the Use of Outpatient Care Services: Quasi‐Experimental Evidence from Panel Count Data," Health Economics, John Wiley & Sons, Ltd., vol. 24(9), pages 1131-1146, September.
    3. João Cotter Salvado, 2008. "The Determinants of Health Care Utilization in Portugal: An Approach with Count Data Models," Swiss Journal of Economics and Statistics (SJES), Swiss Society of Economics and Statistics (SSES), vol. 144(III), pages 437-458, September.
    4. Fabbri, Daniele & Monfardini, Chiara, 2009. "Rationing the public provision of healthcare in the presence of private supplements: Evidence from the Italian NHS," Journal of Health Economics, Elsevier, vol. 28(2), pages 290-304, March.
    5. Jaume Puig & Marc Sáez & Esther Martínez Garcia, 1998. "Health care provider choice in the case of patient-initiated contacts. An extended version of discrete choice of model demand," Working Papers, Research Center on Health and Economics 308, Department of Economics and Business, Universitat Pompeu Fabra.
    6. Moreira S & Pita Barros P, 2009. "Double coverage and demand for health care: Evidence from quantile regression," Health, Econometrics and Data Group (HEDG) Working Papers 09/21, HEDG, c/o Department of Economics, University of York.
    7. Andrea Albanese & Bart Cockx, 2015. "Permanent Wage Cost Subsidies For Older Workers. An Effective Tool For Increasing Working Time And Postponing Early Retirement?," Working Papers of Faculty of Economics and Business Administration, Ghent University, Belgium 15/902, Ghent University, Faculty of Economics and Business Administration.
    8. 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.
    9. Sylvia Brandt & Peter Marie, 2011. "Racial Disparities in Hospital Length of Stay for Asthma: Implications for Economic Policies," Journal of Family and Economic Issues, Springer, vol. 32(1), pages 152-169, March.
    10. Daniele Fabbri & Chiara Monfardini, 2016. "Opt Out or Top Up? Voluntary Health Care Insurance and the Public vs. Private Substitution," Oxford Bulletin of Economics and Statistics, Department of Economics, University of Oxford, vol. 78(1), pages 75-93, February.
    11. Ulf‐ G. Gerdtham, 1997. "Equity in Health Care Utilization: Further Tests Based on Hurdle Models and Swedish Micro Data," Health Economics, John Wiley & Sons, Ltd., vol. 6(3), pages 303-319, May.
    12. Javier Gardeazabal & Todd Sandler, 2015. "INTERPOL's Surveillance Network in Curbing Transnational Terrorism," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 34(4), pages 761-780, September.
    13. Duncan, Kevin Davey, 2020. "Three papers in regional dynamics and panel econometrics," ISU General Staff Papers 202001010800009129, Iowa State University, Department of Economics.
    14. Guido W. Imbens & Jeffrey M. Wooldridge, 2009. "Recent Developments in the Econometrics of Program Evaluation," Journal of Economic Literature, American Economic Association, vol. 47(1), pages 5-86, March.
    15. Juan Camilo Castillo & Daniel Mejía & Pascual Restrepo, 2020. "Scarcity without Leviathan: The Violent Effects of Cocaine Supply Shortages in the Mexican Drug War," The Review of Economics and Statistics, MIT Press, vol. 102(2), pages 269-286, May.
    16. 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.
    17. Sisira Sarma & Wayne Simpson, 2006. "A microeconometric analysis of Canadian health care utilization," Health Economics, John Wiley & Sons, Ltd., vol. 15(3), pages 219-239, March.
    18. Christopher J. Cronin & David K. Guilkey & Ilene S. Speizer, 2019. "Measurement error in discrete health facility choice models: An example from urban Senegal," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 34(7), pages 1102-1120, November.
    19. Martin Huber & Michael Lechner & Andreas Steinmayr, 2015. "Radius matching on the propensity score with bias adjustment: tuning parameters and finite sample behaviour," Empirical Economics, Springer, vol. 49(1), pages 1-31, August.
    20. Barros, Pedro Pita & Machado, Matilde P. & Sanz-de-Galdeano, Anna, 2008. "Moral hazard and the demand for health services: A matching estimator approach," Journal of Health Economics, Elsevier, vol. 27(4), pages 1006-1025, July.

    More about this item

    Keywords

    fixed-effect Poisson regression; fixed-effect truncated Poisson regression; health econometrics; number of doctor visits; propensity score matching; small area variation;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • C23 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Models with Panel Data; Spatio-temporal Models
    • C25 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Discrete Regression and Qualitative Choice Models; Discrete Regressors; Proportions; Probabilities

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:yor:hectdg:14/17. 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: . General contact details of provider: https://edirc.repec.org/data/deyoruk.html .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Jane Rawlings (email available below). General contact details of provider: https://edirc.repec.org/data/deyoruk.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.