Determinants of Access to Physician Services in Italy: A Latent Class Seemingly Unrelated Probit Approach

Atella, Vincenzo; Brindisi, Francesco; Deb, Partha; Rosati, Furio Camillo

doi:10.2139/ssrn.320880

Cited by 35 publications

(47 citation statements)

References 18 publications

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“…Regarding the number of latent classes our results are similar to those obtained in other studies [35,[42][43][44][45] (Bago d'Uva, in press), which have found that FMM with two classes fitted the counts well enough. It is interesting to note that models with c ¼ 3 are preferred when the component distributions are Poisson; in contrast, models with c ¼ 2 are the preferred for negative binomial distributions.…”

Section: Discussionsupporting

confidence: 91%

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

Lourenço¹,

Ferreira²

2005

Health Economics

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SummaryThe impact of time costs on the utilization of medical care has been a subject of theoretical and empirical research since the early 1970s.The main goal of this paper is to show the effect of time costs on the number of visits to general practitioners (GP) in Portuguese public health centres. We measured the elasticity of primary health care utilization relative to the total time spent in the health centre and relative to travel time. We also provided evidence regarding the impact of an appointment delay on the utilization of public GP services.Our data resulted from the application of an endogenous sampling scheme, resulting in a truncated-at-zero data set. To model our dependent variable, number of visits, and accounting for the truncated nature of the data we used a finite mixture model specification.The data were obtained from the most recent implementation in Portugal of the 2003/2004 Europep Survey. The two-component negative binomial II finite mixture model led 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 GP visits per year and a frequent-users class with an estimated utilization mean of 11.1 visits for the remaining 12% of the population.We failed to find any statistically significant elasticity of time cost utilization, when this variable is measured as the total time spent in the health centre. Regarding the effect of an appointment delay on health centre utilization we concluded that individuals respond to this variable by lowering the number of GP visits. This last finding may have policy implications, which will be discussed at the end of the paper.

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Section: Discussionsupporting

confidence: 91%

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

Lourenço¹,

Ferreira²

2005

Health Economics

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“…In previous empirical applications of latent class model to health care utilisation, class membership probabilities were taken as parameters π ij =π j , j=1,… ,C, to be estimated along with θ 1 , …, θ C (see e.g., Deb andTrivedi, 1997 andDeb and Holmes, 2000;Deb, 2001;Jimenez et al;, Atella et al, 2004. These can also be parameterised as functions of time invariant individual characteristics z i .…”

Section: Need Adjustment With the Latent Class Hurdle Modelmentioning

confidence: 99%

Measurement of horizontal inequity in health care utilisation using European panel data

d’Uva

Jones

Doorslaer

2009

Journal of Health Economics

106

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Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Terms of use: Documents in AbstractMeasurement of inequity in health care delivery has focused on the extent to which health care utilization is or is not distributed according to need, irrespective of income. Studies using crosssectional data have proposed various ways of measuring and standardizing for need, but inevitably much of the inter-individual variation in needs remains unobserved in cross-sections. This paper exploits panel data methods to improve the measurement by including the time-invariant part of unobserved heterogeneity into the need-standardization procedure. Using latent class hurdle models for GP and specialist visits estimated on 8 annual waves of the European Community Household Panel we compute indices of horizontal equity that partition total income-related variation in use into a need-and a non-need related part, not only for the observed but also for the unobserved but time-invariant component. We also propose and compare a more conservative index of horizontal inequity to the conventional statistic. We find that many of the cross-country comparative results appear fairly robust to the panel data test, although the panel based methods lead to higher estimates of horizontal inequity for most countries. This confirms that better estimation and control for need often reveals more pro-rich distributions of utilization.

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“…In the paper by Atella et al [16], it is shown that similar latent characteristics underlying differences in utilization between GP and specialist services, seem to be driving the choice between public and private provider of services used in Italy. Higher income individuals are not only more likely to seek medical specialist help, they are also more likely to seek private specialist help.…”

Section: Horizontal Inequities In Health Care Usementioning

confidence: 99%

Income‐related inequality in health and health care in the European Union

Doorslaer

Jones

2004

Health Economics

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Determinants of Access to Physician Services in Italy: A Latent Class Seemingly Unrelated Probit Approach

Cited by 35 publications

References 18 publications

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

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

Measurement of horizontal inequity in health care utilisation using European panel data

Income‐related inequality in health and health care in the European Union

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