Department of Economics, University of Ottawa, Ottawa, Canada.
Health Econ. 2019 Apr;28(4):529-542. doi: 10.1002/hec.3862. Epub 2019 Jan 28.
The objective of this study is to examine the causal effect of health care utilization on unmet health care needs. An IV approach deals with the endogeneity between the use of health care services and unmet health care, using the presence of drug insurance and the number of physicians by health region as instruments. We employ three cycles of the Canadian Community Health Survey confidential master files (2003, 2005, and 2014). We find a robustly negative relationship between health care use and unmet health care needs. One more visit to a medical doctor on average decreases the probability of reporting unmet health care needs by 0.014 points. The effect is negative for the women-only group whereas it is statistically insignificant for men; similarly, the effect is negative for urban dwellers but insignificant for rural ones. Health care use reduces the likelihood of reporting unmet health care. Policies that encourage the use of health care services, like increasing the coverage of public drug insurance and increasing after hours accessibility of physicians, can help reduce the likelihood of unmet health care.
本研究旨在考察医疗保健利用对未满足的医疗保健需求的因果效应。采用 IV 方法,利用药物保险的存在和按卫生区域划分的医生人数作为工具,解决医疗保健服务利用和未满足的医疗保健之间的内生性问题。我们使用了加拿大社区健康调查机密主文件的三个周期(2003 年、2005 年和 2014 年)。我们发现医疗保健利用与未满足的医疗保健需求之间存在显著的负相关关系。平均每多去看一次医生,报告未满足的医疗保健需求的概率就会降低 0.014 个百分点。这种效应在女性群体中为负,但在男性群体中不显著;同样,这种效应在城市居民中为负,但在农村居民中不显著。医疗保健的利用降低了报告未满足的医疗保健需求的可能性。鼓励医疗保健服务利用的政策,如增加公共药物保险的覆盖范围和增加医生的非工作时间可及性,可以帮助降低未满足的医疗保健需求的可能性。