Ellis R P, McInnes D K, Stephenson E H
Department of Economics, Boston University, MA 02215.
Health Econ. 1994 May-Jun;3(3):183-200. doi: 10.1002/hec.4730030307.
This paper uses the results of a household survey conducted in Cairo, Egypt in 1992 to examine the factors that influence the demand for inpatient and outpatient health services. Multi-stage discrete choice models of the demand for health care, which identify the importance of individual, household, and facility level variables on each treatment decision, are estimated separately for outpatients and inpatients. Consumers are assumed to decide whether to seek any treatment and then choose between three categories of providers: a large public hospital (Embaba Hospital), all other public providers, and private/charitable providers. The results confirm that more affluent consumers prefer the higher cost, higher quality private and charitable hospitals. Age, sex, education, and insurance are also found to strongly impact the use of medical services. The results are suggestive but do not conclusively show that inpatient care is less price responsive than outpatient care. Price responsiveness of inpatient and outpatient demand are imprecisely estimated because price is highly correlated with quality, and the available data on facility quality do not permit us to adequately control for quality variations across facilities.
本文利用1992年在埃及开罗进行的一项家庭调查结果，来研究影响住院和门诊医疗服务需求的因素。针对门诊患者和住院患者分别估计了医疗保健需求的多阶段离散选择模型，该模型确定了个体、家庭和机构层面变量在每个治疗决策中的重要性。假定消费者先决定是否寻求治疗，然后在三类医疗服务提供者中进行选择：一家大型公立医院（恩巴巴医院）、所有其他公立医疗服务提供者以及私立/慈善医疗服务提供者。结果证实，较为富裕的消费者更倾向于选择成本更高、质量更高的私立和慈善医院。研究还发现，年龄、性别、教育程度和保险也对医疗服务的使用有强烈影响。研究结果具有一定启发性，但并未确凿表明住院护理的价格反应性低于门诊护理。住院和门诊需求的价格反应性估计并不精确，因为价格与质量高度相关，而且现有的机构质量数据不允许我们充分控制各机构之间的质量差异。
