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Endogenous switching of insurance regime and the demand for health care services among the insured and uninsured

01 Dec 2008-Vol. 3, Iss: 2, pp 77-93

AbstractBir kisinin saglik sigortasinin olmasi sadece saglik hizmetlerine harcadigi parayi degil ayni zamanda saglik hizmetlerine ulasabilmesini de etkiler. Bu calisma sigortalilar ile sigortali olmayanlar arasindaki saglik hizmetleri talebinin belirleyicilerini incelemek icin saglik hizmetleri talebini sigorta rejimleri ile tahmin etmektedir. Sigortanin icselligi ve bagimli degiskenin pozitifligi ve kesikli degisken olmasindan dolayi bu tur bir analiz geleneksel tahmin yontemleri ile yapilamamaktadir. Bundan dolayi bu calismada 1993 Milli Saglik Arastirma Anketi kullanilarak type-5 Tobit modeli olarak da bilinen icsel switching model kullanilmistir. Saglik statuleri arasinda belli anlamli iliskiler gorulmustur. Ornegin, calisan bireyler daha az ameliyat ve hastanede daha az gece yatma talebinde bulunmaktadirlar. Bazi anlamli iliskiler ise sadece bir sigorta turunde gorunmektedir. Ornegin, sigortalilar arasinda daha yuksek egitimli bireylerin daha fazla uzman vizitesi talep ettikleri gozlemlenmistir. Doktor hizmetleri talebinde ise saglik statusunun sigortali olmayanlar arasinda sigortalilara gore daha etkili oldugu gozlemlenmistir. Hastane hizmetleri talebi acisindan ise bu iliskinin ters oldugu gozlemlenmistir. Bu sonuclar gostermektedir ki sigorta bagimsiz degiskenler ile saglik hizmetlerinden faydalanma arasindaki iliskiye etkileyebilmektedir.

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Journal ArticleDOI
Abstract: Sample selection bias as a specification error This paper discusses the bias that results from using non-randomly selected samples to estimate behavioral relationships as an ordinary specification error or «omitted variables» bias. A simple consistent two stage estimator is considered that enables analysts to utilize simple regression methods to estimate behavioral functions by least squares methods. The asymptotic distribution of the estimator is derived.

22,160 citations


Journal ArticleDOI
Abstract: A large number of studies have been made on the impact of labor unions on wage rates of workers. These studies generally have found positive and significant effects of unionism on wage rates. More recently, a few authors have studied the simultaneous effects between unionism and wages. Ashenfelter and Johnson [1972] used aggregated U.S. Manufacturing Industries Data and found that unionism had no significant impact on wage rates, but that the wage rate had a significant effect on the extent of unionism. Since the data they used were quite limited, they could only conclude that the magnitude of the effects of unionism on wage rates was uncertain. Schmidt and Strauss [1976] reached similar conclusions using macroeconomic data. Their mixed logit approach, however, is not based on choice behavior and does not fit into a traditional econometric framework. This study extends recent investigations of the joint determination of the extent of unionism and the effects of unions on wage rates, using macroeconomic data from the Survey of Economic Opportunity Sample of 1967. Economic considerations suggest that the propensity to join a union depends on the net wage gains that might result from trade union membership. The explicit inclusion of this interdependence between the wage gain equation and the union membership equation in the model represents our point of departure from the previous work of Ashenfelter and Johnson and Schmidt and Strauss. The model is a variant of a traditional simultaneous equations model with a binary qualitative variable (union membership) and limited dependent variables. In Section 2, the conceptual framework of the model is discussed. Properties of the data are presented in Section 3. Section 4 briefly discusses estimation methods, and empirical estimates are presented in Section 5. Finally, in Section 6, conclusions are drawn.

1,252 citations


"Endogenous switching of insurance r..." refers methods in this paper

  • ...…the expected utilization of health care services among the insured and uninsured separately;11 the complete interaction in the demand equations (Lee 1978: 11 As stated in Terza (1998), a heteroskedasticity-consistent estimator is used for the asymptotic covariance matrix of the second-stage…...

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Journal ArticleDOI
TL;DR: In the most important health insurance study ever conducted researchers at the RAND Corporation devised all experiment to address two key questions in health care financing: how much more medical care will people use if it is provided free of charge, and what are the consequences for their health?

970 citations


"Endogenous switching of insurance r..." refers methods in this paper

  • ...The econometric methods applied for this analysis are founded on Terza’s (1998) general formulation of a count data regression framework that accommodates both endogenous treatment effects and endogenous regime switching....

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  • ...3 In the path breaking RAND Health Insurance Experiment study, participants were randomly assigned health insurance policies varying by copayment and deductible (Newhouse et al. 1993). All were insured to a maximum out-of-pocket expense of $1,000 and most were covered under the same type of health care system. 4 As part of the RAND Health Insurance Experiment, Manning et al. (1984) randomly assigned participants to a health maintenance organization or fee-for-service plan....

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Journal ArticleDOI
TL;DR: A model for interdependent demand for health insurance and health care under uncertainty is developed to throw light on the issue of insurance-induced distortions in thedemand for health care services.
Abstract: This paper develops a model for interdependent demand for health insurance and health care under uncertainty to throw light on the issue of insurance-induced distortions in the demand for health care services. The model is used to empirically analyse the determinants of the choice of health insurance type and seven types of health care services using micro-level data from the 1977–78 Australian Health Survey. Econometric implementation of the model involves, simultaneously, issues of discreteness of choice, selectivity and stochastic dependence between health insurance and utilization. Health status appears to be more important in determining health care service use than health insurance choice, while income appears to be more important in determining health insurance choice than in determining health care service use. For a broad range of health care services both moral hazard and self selection are found to be important determinants of utilization of health care services.

509 citations


"Endogenous switching of insurance r..." refers background or methods or result in this paper

  • ...Cameron et al. (1988) find that health care service use appears to be income-insensitive. Schellhorn (2001) reports that income does not have a significant effect on both specialist and primary physician visits, (Schellhorn 2001: 441) whereas Vera-Hernandez (1999) finds that income significantly increases the demand for specialist visits. Certain significant relationships only appear in one insurance state. Among the insured, residing in the city increases the demand for physician services, the higher educated individuals demand more specialist visits, employed individuals demand more general practitioner visits and being white increases the demand for nights in the hospital. It is important to note that these results only hold for the insured. Schellhorn (2001) finds that residing in the city increases the demand for specialist visits and both Vera-Hernandez (1999) and Schellhorn (2001) find that the higher educated individuals demand more specialist visits....

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  • ...Cameron et al. (1988) provide a model of individual behavior relevant to decisions about health care and insurance, which provides a setting for the estimation of the interdependent demands of health care and insurance....

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  • ...Following Cameron et al. (1988) and Vera-Hernandez (1999), we apply a practical definition of health based on definitions of disease, illness and disability....

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  • ...Cameron et al. (1988) find that health care service use appears to be income-insensitive. Schellhorn (2001) reports that income does not have a significant effect on both specialist and primary physician visits, (Schellhorn 2001: 441) whereas Vera-Hernandez (1999) finds that income significantly increases the demand for specialist visits....

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  • ...Cameron et al. (1988) find that income is an important determinant of health insurance decision and Vera-Hernandez (1999) finds that income and employment status are very important in determining health insurance choice....

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Journal ArticleDOI
TL;DR: The lower rate of use that the authors observed, along with comparable reductions found in non-controlled studies by others, suggests that the style of medicine at prepaid group practices is markedly less "hospital-intensive" and, consequently, less expensive.
Abstract: Does a prepaid group practice deliver less care than the fee-for-service system when both serve comparable populations with comparable benefits? To answer this question, we randomly assigned a group of 1580 persons to receive care free of charge from either a fee-for-service physician of their choice (431 persons) or the Group Health Cooperative of Puget Sound (1149 persons). In addition, 733 prior enrollees of the Cooperative were studied as a control group. The rate of hospital admissions in both groups at the Cooperative was about 40 per cent less than in the fee-for-service group (P less than 0.01), although ambulatory-visit rates were similar. The calculated expenditure rate for all services was about 25 per cent less in the two Cooperative groups (P less than 0.01 for the experimental group, P less than 0.05 for the control group). The number of preventive visits was higher in the prepaid groups, but this difference does not explain the reduced hospitalization. The similarity of use between the two prepaid groups suggests that the mix of health risks at the Cooperative was similar to that in the fee-for-service system. The lower rate of use that we observed, along with comparable reductions found in non-controlled studies by others, suggests that the style of medicine at prepaid group practices is markedly less "hospital-intensive" and, consequently, less expensive.

500 citations


"Endogenous switching of insurance r..." refers methods in this paper

  • ...7 For applications of this model in various contexts using Terza's (1998) general methodology, see Terza (1998), McGeary and French (2000), and Kenkel and Terza (2001)....

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