Borah Bijan J
Economics Department, Indiana University, IN 47405, USA.
Health Econ. 2006 Sep;15(9):915-32. doi: 10.1002/hec.1166.
In order to address the persistent problems of access to and delivery of health care in rural India, a better understanding of the individual provider choice decision is required. This paper is an attempt in this direction as it investigates the determinants of outpatient health care provider choice in rural India in the mixed multinomial logit (MMNL) framework. This is the first application of the mixed logit to the modeling of health care utilization. We also use the multiple imputation technique to impute the missing prices of providers that an individual did not visit when she was ill. Using data from National Sample Survey Organization of India, we find the following: price and distance to a health facility play significant roles in health care provider choice decision; when health status is poor, distance plays a less significant role in an adult's provider choice decision; price elasticity of demand for outpatient care varies with income, with low-income groups being more price-sensitive than high-income ones. Furthermore, outpatient care for children is more price-elastic than that for adults, which reflects the socio-economic structure of a typical household in rural India where an adult's health is more important than that of a child for the household's economic sustenance.
为了解决印度农村地区在医疗保健获取和提供方面长期存在的问题，需要更好地理解个体医疗服务提供者选择决策。本文朝着这个方向展开研究，在混合多项逻辑回归（MMNL）框架下探究印度农村地区门诊医疗服务提供者选择的决定因素。这是混合逻辑回归在医疗保健利用建模中的首次应用。我们还使用多重填补技术来填补个体生病时未就诊的医疗服务提供者的缺失价格。利用印度国家抽样调查组织的数据，我们发现以下几点：医疗设施的价格和距离在医疗服务提供者选择决策中起着重要作用；当健康状况较差时，距离在成年人的医疗服务提供者选择决策中所起的作用较小；门诊护理的需求价格弹性随收入而变化，低收入群体比高收入群体对价格更敏感。此外，儿童门诊护理的价格弹性高于成人，这反映了印度农村典型家庭的社会经济结构，即对家庭经济维持而言，成人健康比儿童健康更为重要。
