Access to primary care and workers’ opportunity costs. Evidence from Italy

De Luca, Giuliana and Ponzo, Michela (2009): Access to primary care and workers’ opportunity costs. Evidence from Italy.

Abstract

This paper explores whether and to which extent employment condition and working hours influence individuals’ decision process in consuming primary care. The hypothesis is that the higher the workers’ opportunity cost in terms of earning forgone, the less the demand for General Practitioner (GP) visits. Data used in the analysis come from the 2004/2005 “Health conditions and recourse to health services” survey provided by the Italian National Institute of Statistics (ISTAT). We apply a negative binomial regression to model the relationship between the number of GP visits and employment related variables, controlling for a rich set of individual demographic characteristics, socio-economic variables, health status, supply and geographical factors. We show that self-employed workers, managers and cadres use significantly less primary care services notwithstanding the access is free. We interpret these findings as being due to the fact that these type of workers have higher opportunity costs than white and blue collars, since they suffer more from the loss of earnings related to the absence from work

• Item Type: MPRA Paper
• Language: English
• Keywords: Opportunity cost, hours of work, utilisation of GP, labour market.
• Subjects: I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy ; Regulation ; Public Health; J - Labor and Demographic Economics > J2 - Demand and Supply of Labor > J21 - Labor Force and Employment, Size, and Structure; J - Labor and Demographic Economics > J2 - Demand and Supply of Labor > J20 - General; I - Health, Education, and Welfare > I1 - Health > I10 - General

References

Acton, G. (1975), “Non-monetary factors in the demand for medical services: some empirical evidence”, Journal of Political Economy, 83, 549-614.

Ai, C. and Norton E.C. (2003), “ Interaction terms in logit and probit models”, Economics Letters, 80, 123–129.

Andersen, R.M. (1995), “Revisiting the behavioural model and access to medical care: does it matters?”, Journal of Health Socioeconomics Behaviour, 36, 1-10.

Becker, G. (1965), “A theory of the allocation of time”, Economic Journal, 75, 493-517.

Boaz, R. and Muller, C. (1989), “Does having more time after retirement change the demand for physician services?”, Medical Care, 21, 1-15.

Cameron, A.C., Trivedi, P.K., Milne F. and Piggott J. (1988), “A microeconometric model of the demand for health care and health insurance in Australia”, Review of Economic Studies, 55, 85-106.

Cameron, A.C. and Trivedi P.K. (1998), Regression Analysis of Count Data, Cambridge University Press, Cambridge.

Duan, N., Manning, W.G., Morris, C.N. and Newhouse J.P. (1983), “A comparison of alternative models for the demand for medical care”, Journal of Business and Economic Statistics, 2, 115-126.

Economou, A., Nikolaou, A. and Theodossiou, I. (2008), “Socioeconomic status and healthandcare utilization: a study of the effects of low income, unemployment and hours of work on the demand for health care in the European Union”, Health Services Management Research, 21, 40-59.

Fell, B., Kephart, G ., Curtis, J., Bower, K., Muhajarine, N., Reid, R. and Roos, L. (2007), “The Relationship between Work Hours and Utilization of General Practitioners in Four Canadian Provinces”, Health Services Research, 42 , 1483-1498.

Fernández-Olano, C., Hidalgo, R.J., Cerdá-Díaz, R., Requena-Gallego, M., Sánchez-Castaño, C., Urbistondo-Cascales, L., Otero-Puime, A. (2006), “Factors associated with health care utilization by the elderly in a public health care system”, Health Policy, 75, 131-139.

Gravelle, H., Sutton, M., Morris, S., Windmeijer, F., Leyland, A., Dibben, C. and Muirhead, M. (2003), “Modelling supply and demand influences on the use of health care: implications for deriving a needs-based capitation formula”, Health Economics, 12, 985-1004.

Greene, W. (2008), “Functional forms for the negative binomial model for count data”, Economics Letters, 99, 585-590.

Grossman, M. (1982), “The demand for health after a decade”, Journal of Health Economics, 1, 1-3.

Janssen, R. (1992), “Time prices and the demand for GP services”, Social Science & Medicine, 34, 725-733.

Manning, W.G., Morris, C.N., Newhouse, J.P. et al. (1981), “A two-part model of the demand for medical care: preliminary study from the health insurance study”, in Health, Economics, and Health Economics (Ed) Sheffler R.M. and Rossiter, L.F., Amsterdam, North-Holland, 103-123.

Mullahy, J. (1986), “Specification and testing of some modified count data models”, Journal of Econometrics, 33, 341-365.

Mullahy, J. (1997), “Heterogeneity, excess zeros, and the structure of count data models”, Journal of Applied Econometrics, 12, 337-350.

Phelps, C. and Newhouse, J. (1974) Coinsurance, the price of time and the demand for medical services, Review of Economic and Statistics, 56, 334-342.

Pohlmeier, W. and Ulrich, V. (1995), “An econometric model of the two-part decision making process in the demand for health care”, Journal of Human Resources, 30, 339-361.

Van Doorslaer, E., Koolman, X. and Jones A.M. (2004), “Explaining income-related inequalities in doctor utilisation in Europe”, Health Economics, 13, 629-647.

Wagstaff, A. and Van Doorslaer, E. (2000), “Equity in health care finance and delivery”, in Handbook of Health Economics (Eds.) Culyer A.J. and Newhouse J.P., Amsterdam, The Netherlands: Elsevier, 1803-1910.

Wellstood, K., Wilson, K. and Eyles, J. (2006), “Reasonable access to primary care: assessing the role of individual and system characteristics”, Health and Place, 12, 121-130.