ABSTRACT
In this paper the differences in average waiting times are utilized to identify the determinants of demand for health services. The equilibrium waiting time framework is used, but the full equilibrium assumption is relaxed by selecting areas with low waiting times and by estimating a (semi-)parametric selection model. Determinants of supply are used as instruments for the endogeneity of waiting times. A model for the demand for acute services at the ward level in the UK is estimated. The model estimates, and their implications for health service allocations in the UK, are contrasted against more standard allocation models. The present results show that it is critically important to account for rationing by waiting times when identifying needs from care utilization data.
Subject(s)
Health Resources/statistics & numerical data , Health Services Needs and Demand/classification , Hospitals/statistics & numerical data , Models, Statistical , State Medicine/statistics & numerical data , Waiting Lists , Health Care Rationing/organization & administration , Health Resources/economics , Health Services Research , Humans , Regression Analysis , Reproducibility of Results , Sensitivity and Specificity , State Medicine/economics , Statistics, Nonparametric , Time Factors , United KingdomABSTRACT
For small group sizes, the GLS estimator in multilevel models is biased and inconsistent when the random cluster effects are correlated with the regressors. A fixed effects approach, conditioning on the cluster effects, provides consistent estimates for the slope parameters. The two estimators are equivalent when group sizes are large. The same results obtain for two-stage estimation procedures that allow for some of the regressors to be simultaneously determined with the dependent variable. The GLS and fixed effects estimators are applied to data on acute care hospital utilization in the UK, allowing for health authority district effects.
