Dickey H, Ikenwilo D, Norwood P, Watson V, Zangelidis A
Centre for European Labour Market Research (CELMR), Business School, University of Aberdeen, Scotland, UK.
Health Economics Research Unit, University of Aberdeen, Scotland, UK.
Soc Sci Med. 2016 Feb;150:117-27. doi: 10.1016/j.socscimed.2015.12.037. Epub 2015 Dec 28.
Preventive health care is promoted by many organisations from the World Health Organisation (WHO) to regional and national governments. The degree of cost-sharing between individuals and the health care service affects preventive service use. For instance, out-of-pocket fees that are paid by individuals for curative services reduce preventive care demand. We examine the impact of subsidised preventive care on demand. We motivate our analysis with a theoretical model of inter-temporal substitution in which individuals decide whether to have a health examination in period one and consequently whether to be treated if required in period two. We derive four testable hypotheses. We test these using the subsidised eye care policy introduced in Scotland in 2006. This provides a natural experiment that allows us to identify the effect of the policy on the demand for eye examinations. We also explore socio-economic differences in the response to the policy. The analysis is based on a sample from the British Household Panel Survey of 52,613 observations of people, aged between 16 and 59 years, living in England and Scotland for the period 2001-2008. Using the difference-in-difference methodology, we find that on average the policy did not affect demand for eye examinations. We find that demand for eye examinations only increased among high income households, and consequently, inequalities in eye-care services demand have widened in Scotland since the introduction of the policy.
从世界卫生组织（WHO）到地区和国家政府，许多组织都在推广预防性医疗保健。个人与医疗服务之间的费用分摊程度会影响预防性服务的使用。例如，个人为治疗性服务支付的自付费用会降低预防性保健需求。我们研究了补贴性预防性保健对需求的影响。我们用一个跨期替代的理论模型来推动我们的分析，在这个模型中，个人决定是否在第一阶段进行健康检查，以及因此在第二阶段如果需要是否接受治疗。我们得出了四个可检验的假设。我们使用2006年在苏格兰推出的补贴性眼部护理政策来检验这些假设。这提供了一个自然实验，使我们能够确定该政策对眼部检查需求的影响。我们还探讨了对该政策反应中的社会经济差异。该分析基于英国家庭调查面板中2001年至2008年期间居住在英格兰和苏格兰的52613名年龄在16至59岁之间的人的样本。使用差分法，我们发现平均而言该政策并未影响眼部检查需求。我们发现眼部检查需求仅在高收入家庭中有所增加，因此，自该政策推出以来，苏格兰眼部护理服务需求的不平等现象有所加剧。
