What determines a patient’s treatment? Evidence from out of hours primary care co-op data in the Republic of Ireland

Abstract

This study explores consistency in healthcare. It investigates whether vulnerable groups in the population receive the most appropriate care. This is achieved by considering the case study of individuals who present to out of hours (OOH) primary care services in the Republic of Ireland with gastroenteritis. Specifically an individual can potentially receive four services; nurse advice, doctor advice, a treatment centre consultation or a home visit. Results show that service choice is influenced by patient, call and seasonal characteristics to varying degrees. Patient symptoms are the primary driver of the type of service the patients receives. Results also indicate that the OOH primary care facilities individual characteristics do not affect service choice. This suggests a degree of consistent care across these organisations. It also provides evidence that service choice is exogenous to the organisation.

Considering endogeneity and heterogeneity-a hierarchical random parameters approach to measuring efficiency

“…instance, we argue that services are driven by the condition the patient reports when they first contact the co-op, their age, severity and possibly their sex. Lordan (2006a) explores the latter by considering gastroenteritis patients that present to the co-op. This illness category is chosen as it covers a wide range of symptoms, can potentially affect all individuals in the population and its severity varies considerably with patient characteristics.…”

“…The results indicate that patient and call characteristics are the elements that ultimately affect the service the patient receives and find co-op characteristics to be insignificant in this choice. Lordan (2006b) Accepting the hypothesis that services are not determined by the co-op staff but are driven by exogenous factors we may extend equation 1 to allow for panel data and consider one modification:…”

“…The daily payroll for the centre is the output in the SPF and the services offered by these centres enter the production function as inputs. It is argued that these services are exogenous variables (Lordan, 2006a, Lordan 2006b) and are determined by patient characteristics and reported conditions and not the staff within the centre.…”

Socioeconomic status and health outcomes in a developing country

“…2 2 A logit approach could equally have been adopted. Unfortunately, no tests exist to distinguish which model is better in the case of the probit versus logit debate and the choice is very much at the discretion of the researcher (Lordan, 2007). …”