Choice Of Care Provider Research Articles

A study of malaria care provider choice in Ghana

Improved understanding of the factors that influence malaria care seeking behaviour is necessary in order to enhance the effectiveness of current malaria control strategies. This paper empirically examines the factors that affect household choice of malaria treatment options in Ghana. The treatment options considered were choice of a public provider of health care, a private provider, purchase of drugs from a drug store, or self-medication. The results indicate that treatment and time costs are significant factors affecting the choice of health care provider. Education and household size also play an important role in malaria care seeking behaviour. The demand for malaria care is inelastic with respect to costs, and the magnitudes of the elasticities suggest that malaria care is a necessity. The policy implications are addressed.

Modeling Medicare-Eligible Veterans’ Demand for Outpatient Services: A Two-Stage Approach

We apply a utility consistent, combined multinomial choice and count data model to identify factors that affect Medicare-eligible veterans’ outpatient health care usage and provider choice. Our first stage count data regression shows that a shadow cost index for visits calculated from the second stage multinomial choice model is significant in determining the Medicare-eligible veterans’ demand of outpatient services. In the second stage, we specify a multinomial choice model to study veterans’ allocation of outpatient visits between the VA and non-VA health care facilities, and find that veterans’ actual out-of-pocket cost and the distance to the health care facility have significantly negative effects on the probability of choosing the alternative. A number of other factors including family income, means of transportation, race, employment, and disability status are also found to be important at various stages of the decision making. We find some evidence of moral hazard effect in the market for private supplemental health insurance and prescription drugs, but adverse selection does not seem to be a problem for this special population.

Workers' Compensation “Reforms,” Choice of Medical Care Provider, and Reported Workplace Injuries

In the 1990s, many states passed workers' compensation laws to control cost growth. Using a difference-in-differences approach, we determine the impact of these laws on the frequency of reported workplace injuries. In response to restrictions that make it more difficult to file claims, reported days-away-from-work injuries decline, accounting for between 7.0% and 9.4% of the dramatic fall in their frequency in 1991–1997. At the same time, these filing disincentives appear to account for 6.8% of the increase in cases with only restricted work activity, although the evidence is weaker for these injuries. Restricting workers' choice of medical care provider did not appear to reduce the frequency of cases in any nonfatal injury category.

The relationships among quality, value, satisfaction and behavioral intention in health care provider choice: A South Korean study

This research proposes an integrative model of health care consumer satisfaction based on established relationships among service quality, value, patient satisfaction and behavioral intention, and tests it in the context of South Korean health care market. Results based on the data collected from 537 South Korean health care consumers corroborated the causal sequence among these constructs suggested by the multiattribute attitude model framework, i.e., cognition (service quality and value)→affect (satisfaction)→conation (behavioral intention). Between the two cognitive constructs, service quality emerged as a more important determinant of patient satisfaction than value. Results also showed that both service quality and value have a significant direct impact on behavioral intention while value assessment was influenced by perceived service quality.

Cost shifting revisited: the case of service intensity.

This paper examines whether a health care provider's choice of service intensity for any patient group affects its cost shifting behavior. Our theoretical models indicate that firms may respond to lower prospective payment by decreasing service intensity to all of its patient groups, thereby giving firms an alternative to cost shifting. Additionally, the conditions under which cost shifting and lower service intensity occur are identical, regardless of profit status. Using a panel of California hospitals, we found that nonprofit hospitals do cost shift, while profit-maximizing hospitals do not. However, both firms respond to lower prospective payment by decreasing service intensity, thus supporting our theoretical conclusion that lower service intensity can be used as an alternative to cost shifting.

An Analysis of Kin‐Provided Child Care in the Context of Intrafamily Exchanges

Little is known about why parents choose kin‐provided child care and less is known about how kin‐provided child care is related to other forms of in‐kind support from relatives close‐at‐hand. Previous models of the choice of kin‐provided child care assumed that the presence of other forms of in‐kind support from relatives nearby was inconsequential to estimating effects of economic and demographic factors on the decision to use kin‐provided child care. Using data from the National Longitudinal Survey of the Class of 1972, this study shows that this assumption is incorrect because use of kin‐provided child care and intrafamily in‐kind resource exchanges are interrelated. When the association between use of kin‐provided child care and the presence of other family in‐kind exchanges is ignored, the study shows that estimated effects for income, the price of child care, and maternal characteristics are underestimated. The findings provide a better understanding of why parents choose kin‐provided child care by confirming that this decision is a part of a larger set of parental decisions about involvement in resource exchanges within extended families. My findings support recent child care bills aiming to increase parental choice of child care provider, broaden the definition of a provider to include non‐coresident relatives, and expand price subsidies for kin‐provided child care.

Flexible Discrete Choice Demand Models Consistent With Utility Maximization: An Application to Health Care Demand

policies, a considerable literature has developed to estimate the economic determinants of health care provider choice. One important goal of this literature has been the estimation of price elasticities of health care demand, particularly in rural areas of developing countries where debates continue regarding appropriate levels of user fees in government health facilities (World Bank). Accurate estimation of price elasticities is crucial to evaluating the trade-offs between health promotion and revenue generation in rural areas where poorly funded government clinics are often consumers' only accessible health care choices. However, the exact empirical implementation of demand estimation with discrete data has be-

Why do patients prefer hospital emergency visits? A nested multinomial logit analysis for patient-initiated contacts.

This paper analyzes the nature of health care provider choice in the case of patient-initiated contacts, with special reference to a National Health Service setting, where monetary prices are zero and general practitioners act as gatekeepers to publicly financed specialized care. We focus our attention on the factors that may explain the continuously increasing use of hospital emergency visits as opposed to other provider alternatives. An extended version of a discrete choice model of demand for patient-initiated contacts is presented, allowing for individual and town residence size differences in perceived quality (preferences) between alternative providers and including travel and waiting time as non-monetary costs. Results of a nested multinomial logit model of provider choice are presented. Individual choice between alternatives considers, in a repeated nested structure, self-care, primary care, hospital and clinic emergency services. Welfare implications and income effects are analyzed by computing compensating variations, and by simulating the effects of user fees by levels of income. Results indicate that compensating variation per visit is higher than the direct marginal cost of emergency visits, and consequently, emergency visits do not appear as an inefficient alternative even for non-urgent conditions.

What really matters: Adolescents' view of factors affecting their health care provider choice: Mark Thomas, M.D., David Teaster, M.D., David Redden, Ph.D., University of Alabama at Birmingham, Birmingham, AL, Chattanooga Unit-University of Tennessee College of Medicine, Chattanooga, TN

What really matters: Adolescents' view of factors affecting their health care provider choice: Mark Thomas, M.D., David Teaster, M.D., David Redden, Ph.D., University of Alabama at Birmingham, Birmingham, AL, Chattanooga Unit-University of Tennessee College of Medicine, Chattanooga, TN

Search behavior and choice of physician in the market for prenatal care.

The authors examine how 963 expectant mothers in Florida searched for and selected a prenatal care provider. Overall, the results suggest that women search for prenatal care in much the same way as search theory predicts. Nevertheless, the amount of search reported is surprisingly small. Less than a quarter of the women in the survey seriously considered more than one physician, and even among this group, less than 60% actually spoke to or visited a second physician. Because of the timing, importance, and relative frequency of pregnancy, it is probably easier to search for a prenatal care provider than it is to search for most other medical services. Consequently, if search is this uncommon for prenatal care providers, it is probably even less common for other procedures. As they search for and choose a prenatal care provider, pregnant women rely most heavily on information from friends and acquaintances. Women facing high coinsurance rates or whose choices are constrained by HMO or Medicaid coverage rely less on recommendations from friends and acquaintances. These women also appear less satisfied with their choice of prenatal care provider.

Use of traditional and orthodox health services in urban Zimbabwe.

Health care in Zimbabwe is provided by both orthodox and traditional care providers. With formal medical services under economic strain it is important to understand the extent of consulting with traditional care providers and their effectiveness. A cross-sectional community survey recorded consultations and self-treatment for episodes of illness among 1251 individuals in 222 households randomly selected in two high-density suburbs of Harare, Zimbabwe. Three dependent variables (illness experience, consultation behaviour and choice of care provider) were analysed against a range of sociodemographic, episode-related and outcome measures. More than one-third of the sample had experienced an illness and 83% of these had led to consultation. Medical services were consulted eight times more often than traditional ones. Non-consulting behaviour was associated with lack of money or low perceived significance of problems. Physical problems were usually taken to medical clinics where their outcome was better, but non-specific pain and other problems did no better with medical or traditional care. While members of the community appear to recognize physical problems and take them to medical care, traditional and orthodox medical consultations appear to be equally effective for non-specific pain or non-specific physical problems. The role of traditional medicine in relation to non-specific physical problems and psychological problems is one which deserves further examination from both clinical and administrative perspectives. Poverty appears to be associated with poorer outcomes; this is a potentially important issue in times of increasing economic hardship.

Ethnic differences in midwife-attended US births.

This study examined US ethnic differences in midwifery care from 1982 through 1989. After adjustment for maternal characteristics, Native American mothers were most likely, and White and Asian mothers were least likely, to obtain midwifery care. For these three groups, midwifery use increased rapidly in the period from 1982 through 1989. Compared with White mothers, Black and Hispanic mothers were more likely to be attended by a midwife; however, their use of midwives increased more slowly. Though the local availability of obstetricians and midwives may determine a woman's choice of care provider, these data suggest that cultural factors also play a role.

Factors affecting the utilization of prenatal health care services in Jerusalem.

Health service utilization patterns during pregnancy were studied among 780 women from selected neighborhoods of Jerusalem who delivered between December 1, 1985 and June 30, 1986. Factors affecting the choice of care-provider, the timing of the first contact with the prenatal care service and the frequency of visits to prenatal care centers were studied with respect to several demographic, socio-economic and needs variables. About one half of the women visited the Family Health Centers, the traditional site for delivery of prenatal care. Forty percent visited their regular doctor during pregnancy while about 30% sought private care. In all, fifty two percent of women consulted more than one source of medical care service during pregnancy. Logistic regression analysis showed that the choice of care was determined by the type of insurance, need factors and education. The timing of the first visit depended on origin, level of education and parity. The frequency of visits was related to the type of insurance and to perceived health.

Medical Cost Containment for Workers' Compensation

Medical Cost Containment for Workers' Compensation Introduction Workers' compensation affects everyone--even employees who never suffer a job-related illness or injury, or employers who never have to handle a workers' compensaton claim. Why? Because the cost of this state-mandated coverage, together with the cost of workers' compensation claims, is part of the cost of doing business. Higher workers' compensation costs result in higher prices for consumers. So everyone has a stake in what is happeing in this arena. While most people are aware that health costs, in general, have been skyrocketing over the past decade, the lion's share of the attention focused on the problem has been aimed at the employee and individual health care arenas. And not without reason. Inflation in this area is running about 10 percent annually--well ahead of the general inflations rate--for a staggering total national expenditure of about $620 billion in 1989. That's a frightening 11.5 percent of America's Gross National Product. However, the inflatin rate in workers' compensation medical claims is even worse, about 14.9 percent annually. And it's time that employers, employees, insurers, academicians, and regulators alike turn their attention to this problem. Just a decade ago, medical costs accounted for about one-third of workers' compensation paid losses. Today, they are almost half of paid losses, more than any other category of workers' compensation costs, including permanent injury claims, indemnity benefits and litigation, according to the Workers' Compensation Insurance Rating Board. Costs of this kind have tremendous impact on companies. Obviously, the higher the costs, the more it hurts competitiveness. And, as has already been pointed out, it comes back to haunt consumers in the form of higher prices. That's the bad news. The good news is, it's possible to do something about t. And now is the time to do it, improve our nation's ability to compete in world markets and keep a healthy economy here at home. The additional good news is, there are techniques for containing or reducing workers' compensation medical costs that will also help ill or injured employees receive better care. This article describes some of the techniques CIGNA is using to achieve these objectives. But, first, some background will help put both the problem and its remedies into context. A mere 76 years ago, there were no compulsory insurance coverages or other first party compensation programs for those who suffered injuries or developed an illness as a result of their work conditions. If they could not work, they were simply out of luck except for possible third party claims against their employer and such claims were usually unsuccessful. Today, in all 50 states and the District of Columbia, workers' compensation provides two basic types of benefits: medical and indemnity as a result of a compensable illness or injury contracted or suffered on the job. Indemnity benefits pay claimants for a portion of wages lost. Medical benefits are payable for necessary medical care, even if no indemnity beneftis are payable. Beyond these basics, however, there are more diferences than similarities among workers' compensatin regulations. Benefit levels, administration and procedures for delivery of care to claimants all vary from state to state. For example, some states specify only that the amount of medical benefits paid on behalf of an ill or injured employee be fair and reasonable, or usual and customary, while others have developed extensive fee schedules. Some statutes provide the injured or ill workers with free choice of medical care provider. Others give the employer the right to direct the injured employee to a particular physician or medical facility. And still others mandate the use of state-approved doctors and facilities. These differences stem from the age of the workers' compensation system, as well as from th e fact that is was created on a piecemeal, state-by-state basis. …

Direct Reimbursement to Nurse Practitioners

This article discusses H.R. 382: The Federal Employees Health Care Freedom of Choice Act, first introduced to Congress in 1987. This act would directly reimburse nurses, nurse practitioners, nurse midwives, family and marriage therapists, and chiropractors under the Federal Employees Health Benefits Program. Few third-party payers currently directly reimburse nurse practitioners. Passage of H.R. 382 is important because it would increase health care availability, make provisions for cost-effective care and increase provider choice. Direct reimbursement to nurse practitioners would not increase health insurance premiums, according to the Office of Personnel Management and the Congressional Budget Office. Suggested strategies for nurse practitioners to lobby for the bill are discussed.

Non-price rationing and the choice of medical care providers in rural Cote d'Ivoire

This paper investigates the role of travel time in rationing medical care services in a developing country where monetary prices are zero. A nested multinomial logit model of provider choice is estimated using 1985 data from rural Côte d'Ivoire. Unlike previous studies of health care demand in developing countries, our results indicate that travel time plays an important role in rationing health care, and that medical care demand for poorer individuals is substantially more travel time elastic than for richer individuals.