An Econometric Model of the Two-Part Decisionmaking Process in the Demand for Health Care

Pohlmeier, Winfried; Ulrich, Volker

doi:10.2307/146123

Cited by 402 publications

(389 citation statements)

References 14 publications

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“…In the context of higher utilization levels of general medical care by people with statutory health insurance (Andersen and Schwarze 1997; Bergmann et al 2005;Gruber and Kiesel 2009;Pohlmeier and Ulrich 1995;Thode et al 2005), it seems reasonable to suppose that the latter group receives more medical care from specialists in return and to test this statement with current data again. Gruber and Kiesel (2009) showed that privately insured persons have lower general practitioner utilization than people with statutory health insurance.…”

Section: Introductionmentioning

confidence: 95%

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Inequality in health care utilization in Germany? Theoretical and empirical evidence for specialist consultation

Gruber

Kiesel²

2010

J Public Health

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Aim In view of increasing concern about a two-class system in the German health care sector, this study investigates the relevance of health insurance schemes and other socioeconomic characteristics to the level of specialist health care provision. Subjects and Methods Referring to Ronald M. Andersen's model of health care utilization and more content-based approaches, we implement a negative binomial hurdle regression to estimate the number of specialist visits within the last 12 months. Our data source is the German sample of the first wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) in 2004.Results The results show that men's number of specialist visits is markedly sensitive to predisposing and enabling factors, whereas women's health care utilization depends less on such socioeconomic characteristics. With reference to previous findings concerning general practitioner consultation, the assumption of a bipolar health care system providing general practitioner care primarily to the statutory insured and specialist care to the privately insured is supported empirically as to men. Education, which is considered to be highly correlated with health lifestyles, has a positive effect on medical health care. Every additional year of education increases by about 10% the probability of men seeking specialist consultation. Furthermore, the results indicate an unfavorable situation for the self-employed concerning health care because of their specific employment situation and health insurance coverage. Discussion The research results suggest the existence of relevant differences in the amount of specialist consultation according to health insurance and other socioeconomic features. Further research could concentrate on the question of whether these inequalities in utilization levels indicate overprovision or underprovision of ambulant health care. Moreover, we recommend longitudinal research that is particularly suited to detangle age and cohort effects.

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Section: Introductionmentioning

confidence: 95%

“…This correlation has also been found in Switzerland (Bisig and Gutzwiller 2004). In Germany, an impact of private health insurance on specialist health care use could not be confirmed yet (Andersen and Schwarze 1997;Pohlmeier and Ulrich 1995).…”

Section: Introductionmentioning

confidence: 99%

Inequality in health care utilization in Germany? Theoretical and empirical evidence for specialist consultation

Gruber

Kiesel²

2010

J Public Health

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“…This survey was implemented through a research company with which the sample households contract (2) . The number of distribution is 1300, that of collection is 1249.…”

Section: Data Descriptionmentioning

confidence: 99%

“…As many kinds of micro data have become available [9], most research has confirmed that "the demand for health care falls with increases in out-of-pocket costs", but that "the magnitude of the estimated response varies widely [10]. Reflecting this situation, highly developed statistical models are often utilized ( [2], [11], [12]). As for Japan, some use aggregate data ( [13], [14]), others use micro data ( [15], [16], [17]) to find a statistically significant negative price elasticity As Gilleski [5] describes, many studies, which consist of a Probit equation for the probability that people consult doctors or linear equations for medical expenditures, implicitly assume that people decide to consult a doctor or not before they get sick.…”

Section: Econometric Specificationmentioning

confidence: 99%

“…This means that how much medical service to consume depends not only on the decisions by the patients. Therefore, when we consider policy to control the behavior of patients, we must also analyze the behavior controlling the effect of physicians ( [2] , [3]). This paper focuses on the initial contact of patients with physicians, such as the timing of starting going to hospital or hospital choice.…”

Section: Introductionmentioning

confidence: 99%

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When do people visit a doctor?

Bessho

Ohkusa

2006

Health Care Manage Sci

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We examine the length of time between when an individual feels sick and when he/she visits a doctor using survival analysis to capture the dynamic aspects of this behavior. If the disease is light, actions such as OTC medicine or sick leave are alternatives to visiting a clinic or a hospital immediately. The timing of the visit depends only the person's decision, not on a doctor's, so we can limit discussion to the effect of ex-post moral hazard excluding physician induced demand. Participants were asked to keep a log of illness-related behavior such as dates of episodes, subjective symptoms, sick leaves, and medical treatment at hospitals.Neither the copayment rate nor access cost had a significant effect on the behavior of visiting a doctor, whereas available alternatives delay the timing of a visiting. Severe symptoms and fever hastened the time. The results suggest that the traditional argument about ex-post moral hazard is somewhat misleading. JEL: I11.

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Incremental Health Care Expenditure of Chronic Cutaneous Ulcers in the United States

et al. 2019

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An Econometric Model of the Two-Part Decisionmaking Process in the Demand for Health Care

Cited by 402 publications

References 14 publications

Inequality in health care utilization in Germany? Theoretical and empirical evidence for specialist consultation

Inequality in health care utilization in Germany? Theoretical and empirical evidence for specialist consultation

When do people visit a doctor?

Incremental Health Care Expenditure of Chronic Cutaneous Ulcers in the United States

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