Effects of Geographical Accessibility on the Use of Outpatient Care Services: Quasi‐Experimental Evidence from Panel Count Data

Abstract

In 2010-2012 new outpatient service locations were established in Hungarian micro-regions, which had lacked such capacities before. We exploit this quasi-experiment to estimate the effect of geographical accessibility on outpatient case numbers using both individual-level and semi-aggregate panel data. We find a 24-27 per cent increase of case numbers as a result of the establishments. Our specialty-by-specialty estimates imply that a one-minute reduction of travel time to the nearest outpatient unit increases case numbers e.g. by 0.9 per cent in internal care and 3.1 per cent in rheumatology. The size of the new outpatient capacities has a separate effect, raising the possibility of the presence of supplier-induced demand.By combining a fixed-effects logit and a fixed-effects truncated Poisson estimator, we decompose the effects into increases in the probability of ever visiting a doctor on the one hand and an increase of the frequency of visits on the other. We find that new visits were dominant in the vast majority of specialties, whereas both margins were important e.g. in rheumatology. Finally, we demonstrate the usefulness of the fixed-effects truncated Poisson estimator in modelling count data by examining its robustness by simulations.3

The effect of primary care availability on antibiotic consumption in Hungary: a population based panel study using unfilled general practices

“…Our results are in line with the literature showing that geographical distance to healthcare facilities negatively affects healthcare use (Haynes et al , Hyndman et al , Elek et al 30–32, among others). Also, we contribute to the literature on the determinants of antibiotic prescribing behaviour of GPs.…”

How does retirement affect healthcare expenditures? Evidence from a change in the retirement age

“…Second, GPs have no incentives to avoid referrals to specialists (Gaál et al, ). These institutional circumstances imply a relatively high usage rate of specialist outpatient care (Elek, Váradi, & Varga, ), which is also reflected in the data we use (we observe positive specialist care expenditures for the vast majority of people aged 54–63). Therefore, the effect of retirement on total outpatient care expenditures is likely to be captured well with our measure despite the fact that we do not observe expenditures on GP services.…”

Unmet medical needs in ambulatory care in Hungary: forgone visits and medications from a representative population survey

“…In contrast to the EHIS data where this share was 2.6% for the year 2014 [10], and SILC data where the share of unmet needs for medical examination due to distance was stable for the last 3 years, 0.2% (2016–2018) [6]. The Hungarian government tried to address the problem of geographical access to outpatient care between 2010 and 2012, when new outpatient units were built in 20 rural micro-regions [18]. After the project implementation, about 430,000 people were able to access health premises within 20-min by car.…”

“…After the project implementation, about 430,000 people were able to access health premises within 20-min by car. On the other hand, according to the estimations, at least for 1.6 million people (16% of the population of Hungary) it still takes more than 20-min by car to get to an outpatient clinic [18]. …”