Cheng Terence C, Costa-I-Font Joan, Powdthavee Nattavudh
University of Adelaide.
London School of Economics.
Am J Health Econ. 2018 Winter;4(1):26-50. doi: 10.1162/ajhe_a_00092. Epub 2018 Jan 23.
We exploit lottery wins to investigate the effects of exogenous changes to individuals' income on the utilization of health care services, and the choice between private and public health care in the United Kingdom. Our empirical strategy focuses on lottery winners in an individual fixed effects framework and hence the variation of winnings arises from within-individual differences in small versus large winnings. The results indicate that lottery winners with larger wins are more likely to choose private health services than public health services from the National Health Service. The positive effect of wins on the choice of private care is driven largely by winners with medium to large winnings (win category £500 (or US$750); mean = £1922.5 (US$2,893.5), median = £1058.2 (US$1592.7)). There is some evidence that the effect of winnings vary by whether individuals have private health insurance. We also find weak evidence that large winners are more likely to take up private medical insurance. Large winners are also more likely to drop private insurance coverage between approximately 9 and 10 months earlier than smaller winners, possibly after their winnings have been exhausted. Our estimates for the lottery income elasticities for public health care (relative to no care) are very small and are not statistically distinguishable from zero; those of private health care range from 0 - 0.26 for most of the health services considered, and 0.82 for cervical smear.
我们利用彩票中奖来研究个人收入的外生变化对医疗保健服务利用的影响，以及英国私人医疗保健与公共医疗保健之间的选择。我们的实证策略聚焦于个体固定效应框架下的彩票中奖者，因此奖金的变化源于个体自身小额奖金与大额奖金的差异。结果表明，奖金数额较大的彩票中奖者比从国民医疗服务体系获取公共医疗服务更倾向于选择私人医疗服务。奖金对选择私人医疗的积极影响在很大程度上是由中等到大额奖金的中奖者（中奖类别为500英镑（或750美元）；均值 = 1922.5英镑（2893.5美元），中位数 = 1058.2英镑（1592.7美元））驱动的。有证据表明，奖金的影响因个人是否拥有私人医疗保险而有所不同。我们还发现微弱的证据表明大额中奖者更有可能购买私人医疗保险。大额中奖者也比小额中奖者更有可能在大约提前9到10个月放弃私人保险覆盖，这可能是在他们的奖金耗尽之后。我们对公共医疗保健（相对于不接受治疗）的彩票收入弹性估计非常小，且在统计上与零没有显著差异；对于大多数所考虑的医疗服务，私人医疗保健的彩票收入弹性范围为0 - 0.26，而子宫颈涂片检查的弹性为0.82。
