Mosely R R, Wolinsky F D
Med Care. 1986 Jun;24(6):496-510. doi: 10.1097/00005650-198606000-00004.
It has traditionally been assumed that obtaining health and illness behavior data by proxy on household members who are not present during the actual interview presents no significant threats to the internal validity of subsequent analyses. Using data on the 78,439 adults interviewed in person or by proxy (about 37% of the total adult sample) as part of the 1978 Health Interview Survey, the authors examine whether the use of proxy respondents alters the results of empirical assessments of the behavioral model of health services utilization or the policy implications that can be derived from it. Two important findings emerge from these analyses. On the one hand, failing to consider explicitly the possibility of a proxy effect (i.e., including a proxy variable in the analyses) does not alter the effect parameters estimated for the behavioral model. On the other hand, failing to consider explicitly the effect of using proxies appears to underestimate slightly physician and hospital contact rates (by 4% and 2%, respectively), as well as the volume of physician utilization. The substantive and policy implications of these findings are discussed, as are two alternative explanations that suggest that proxy-respondents simply use fewer health services either because they are "too busy" or because they are in slightly better health.
传统上人们认为，在实际访谈时不在场的家庭成员由他人代理获取其健康与疾病行为数据，不会对后续分析的内部效度构成重大威胁。作为1978年健康访谈调查的一部分，作者利用对78439名成年人进行当面访谈或他人代理访谈的数据（约占成年样本总数的37%），研究使用代理受访者是否会改变对卫生服务利用行为模型的实证评估结果或从中得出的政策含义。这些分析得出了两个重要发现。一方面，未明确考虑代理效应的可能性（即在分析中纳入代理变量）并不会改变为行为模型估计的效应参数。另一方面，未明确考虑使用代理的影响似乎会略微低估医生诊疗率和住院率（分别低估4%和2%）以及医生服务利用量。文中讨论了这些发现的实质内容和政策含义，还讨论了另外两种解释，这两种解释表明代理受访者只是因为“太忙”或健康状况稍好而使用的卫生服务较少。
