Economics and Public Policy, Indian School of Business, India; Indian Institute of Management, Bangalore, India.
Indian Institute of Management, Bangalore, India; Gokhale Institute of Politics and Economics, Pune, India.
Soc Sci Med. 2018 Jan;196:131-141. doi: 10.1016/j.socscimed.2017.11.021. Epub 2017 Nov 16.
What is the role of spatial peers in diffusion of information about health care? We use the implementation of a health insurance program in Karnataka, India that provided free tertiary care to poor households to explore this issue. We use administrative data on location of patient, condition for which the patient was hospitalized and date of hospitalization (10,507 observations) from this program starting November 2009 to June 2011 for 19 months to analyze spatial and temporal clustering of tertiary care. We find that the use of healthcare today is associated with an increase in healthcare use in the same local area (group of villages) in future time periods and this association persists even after we control for (1) local area fixed effects to account for time invariant factors related to disease prevalence and (2) local area specific time fixed effects to control for differential trends in health and insurance related outreach activities. In particular, we find that 1 new hospitalization today results in 0.35 additional future hospitalizations for the same condition in the same local area. We also document that these effects are stronger in densely populated areas and become pronounced as the insurance program becomes more mature suggesting that word of mouth diffusion of information might be an explanation for our findings. We conclude by discussing implications of our results for healthcare policy in developing economies.
空间邻居在医疗保健信息传播中扮演什么角色？我们利用印度卡纳塔克邦实施的一项医疗保险计划来探讨这个问题，该计划为贫困家庭提供免费的三级保健服务。我们使用该计划从 2009 年 11 月至 2011 年 6 月的 19 个月内（10507 条观测值）的患者位置、患者住院的情况和住院日期的行政数据来分析三级保健的时空聚类。我们发现，今天的医疗保健使用与未来同一地区（村庄组）的医疗保健使用增加有关，这种关联在我们控制了（1）当地固定效应以解释与疾病流行相关的时间不变因素和（2）当地特定时间固定效应以控制健康和保险相关外联活动的差异趋势后仍然存在。具体来说，我们发现今天每新增一次住院治疗，未来同一地区同一疾病的住院治疗就会增加 0.35 次。我们还记录到，在人口密集地区，这些影响更为明显，而且随着保险计划的成熟，这些影响变得更加显著，这表明信息的口碑传播可能是我们研究结果的一个解释。最后，我们讨论了我们的研究结果对发展中经济体医疗保健政策的影响。
