health econometrics

This paper considers the influence of patients' characteristics on their evaluation of a health system's responsiveness, that is, a system's ability to respond to the legitimate expectations of potential users regarding non-health enhancing aspects of care (Valentine et al. 2003a). Since responsiveness is evaluated by patients on a categorical scale, their selfevaluation can be affected by the phenomenon of reporting heterogeneity (Rice et al. 2012). A few studies have investigated how standard socio-demographic characteristics influence the reporting style of health care users with regard to the question of the health system's responsiveness (Sirven et al. 2012, Rice et al. 2012). However, we are not aware of any studies that focus explicitly on the influence that both the patients' state of health and their experiencing of pain have on the way in which they report on system responsiveness. This paper tries to bridge this gap by using data regarding a sample of patients hospitalized in four Local Health Authorities (LHA) in Italy's Emilia-Romagna region between 2010 and 2012. These patients have evaluated 27 different aspects of the quality of care, concerning five domains of responsiveness (communication, social support, privacy, dignity and quality of facilities). Data have been stratified into five sub-samples, according to these domains. We estimate a generalized ordered probit model (Terza, 1985), an extension of the standard ordered probit model which permits the reporting behaviour of respondents to be modelled as a function of certain respondents' characteristics, which in our analysis are represented by the variables "state of health" and "pain". Our results suggest that unhealthier patients are more likely to report a lower level of responsiveness, all other things being equal, while patients experiencing pain are more likely to make use of the extreme categories of responsiveness, that is, to choose the category "completely dissatisfied" or the category "completely satisfied". These results hold across all five domains of responsiveness.

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“…In these cases, covariates have a differential impact across cut-points. This is referred to as a "non-parallel shift" (Jones et al 2007). …”

Section: Econometric Models and Empirical Strategymentioning

confidence: 99%

Are bad health and pain making us grumpy? An empirical evaluation of reporting heterogeneity in rating health system responsiveness

Fiorentini

Ragazzi

Robone

2015

Social Science & Medicine

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“…Thus, this alternative approach separates the participation decisions from the demand equations. It can be estimated as a generalized Heckman (1976) selection model (Poirier, 1980) or in the fashion of a two part model; see Jones (2000) for a discussion of both econometric approaches. In the former models (Heckman, 1976;Poirier, 1980) identification critically relies on valid exclusion restrictions, i.e.…”

Section: The Econometric Specificationmentioning

confidence: 99%

Tobacco and alcohol: complements or substitutes?

et al. 2012

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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 AbstractThe question of whether alcohol and tobacco are consumed as complements or substitutes is crucial for determining the side-effects of anti-smoking policies. Numerous papers have empirically addressed this issue by estimating demand systems for alcohol and tobacco and subsequently calculating cross-price effects. However, this traditional approach is often seriously hampered by insufficient price variation observed in survey data. We therefore suggest an alternative instrumental variables approach that statistically mimics an experimental study and does not rely on prices as explanatory variables. This approach is applied using German survey data. Our estimation results suggest that a reduction in tobacco consumption results in a moderate reduction in alcohol consumption. It is demonstrated that this implies that alcohol and tobacco are complements. Hence, we conclude that successful anti-smoking policies will not result in the unintended side-effect of an increased (ab)use of alcohol. complements or substitutes interdependence in consumption tobacco and alcohol insufficient price-variation instrumental variables approach JEL Classification C31 · D12 · I12

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“…Empirical strategies for modeling such data, in the context of a regression with homoskedastic errors estimated by least squares, have been discussed by Duan et al (1983) and Mullahy (1998), and more generally by Manning and Mullahy (2001). They have been surveyed extensively by Jones (2000), among others. Because the two-part model (TPM), pioneered by the RAND researchers in their analysis of the expenditure data from the RAND Health Insurance Experiment, is a widely used example of such a mixture model, it provides a point of departure for this paper.…”

Section: Introductionmentioning

confidence: 99%

Bayesian analysis of the two‐part model with endogeneity: application to health care expenditure

Deb

Munkin

Trivedi

2006

J of Applied Econometrics

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SUMMARYThis paper studies the effect of managed care on medical expenditure using a model in which the insurance status is assumed to be endogenous. Insurance plan choice is modeled through the multinomial probit model. The medical expenditure variable, the outcome of interest, has a significant proportion of zeros that are handled using the two-part model, extended to handle endogenous insurance. The estimation approach is Bayesian, based on the Gibbs Sampler. The model is applied to a sample of 20 460 individuals obtained from the Medical Expenditure Panel Survey. The results provide substantial evidence of selectivity.

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health econometrics

Cited by 27 publications

References 60 publications

Are bad health and pain making us grumpy? An empirical evaluation of reporting heterogeneity in rating health system responsiveness

Are bad health and pain making us grumpy? An empirical evaluation of reporting heterogeneity in rating health system responsiveness

Tobacco and alcohol: complements or substitutes?

Bayesian analysis of the two‐part model with endogeneity: application to health care expenditure

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