Coinsurance, The Price of Time, and the Demand for Medical Services

Abstract

This paper does not necessarily reflect the opinions or policies of these two organizations. We would particularly like to thank Bridger Mitchell for comments on previous drafts of this paper, although he does not acquire liability for remaining errors by having saved us from previous ones.

Utilization of public health centres in Portugal: effect of time costs and other determinants. Finite mixture models applied to truncated samples

“…Our modelling framework led us to the identification of two different latent classes of health centre users: a low-users class that comprises 88% of patients with an estimated utilization mean of 4.3 visits in the course of an year, and a frequent-users class with an estimated utilization mean of 11.1 visits for the remaining 12% of the population. The rationale used to select the covariates and to interpret their effect on the utilization was based on theoretical models developed by other authors [1,2,17,32].…”

“…Acton [1] shows that the necessary assumptions that make money function as a price in determining the demand for health care are sufficient to make time function as a price. Furthermore, the impact of this kind of time costs is stronger when the monetary cost is low relative to the time cost [1,2]. We then anticipate that travel time and time spent at the health centre are factors which, on average, decrease utilization.…”

“…The covariates used in this paper were those generally used in other studies on the determinants of health care utilization, being their selection based on theoretical models developed by other authors [1,2,17,32]. Table 2 shows the definitions and summary statistics of the covariates, which are assumed to be determinants of the health centre utilization.…”

“…Despite the theoretical and empirical interest in this issue [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15], only a few authors in Portugal have tested the impact of time costs on the medical care utilization, mainly on hospital care [14]. This paper provides evidence on this matter describing the results of an empirical analysis of the responses of GP visits to time costs in health centres.…”

“…In addition, the health reasons that drive the demand for primary health care are totally different from those related to hospital care, therefore precluding the direct extrapolation of the results obtained in these studies to the Portuguese GP demand. Concerning the studies dealing with the effects of physical waiting in the utilization of medical services [1][2][3][4][5][6]19,20] it is also difficult to extrapolate their findings to the demand of GP services. Besides being a little outdated, almost all these studies analyse medical care categories different from those examined in this paper, and more important, in health systems with different organizations.…”