nep-dcm New Economics Papers
on Discrete Choice Models
Issue of 2009‒10‒10
two papers chosen by
Philip Yu
Hong Kong University

  1. Evaluating changes in women's attitudes towards cervical screening following a screening promotion campaign and a free vaccination program. CHERE Working Paper 2009/3 By Meliyanni Johar; Denzil Fiebig; Marion Haas; Rosalie Viney
  2. Four Empirical Essays on the Market for General Practitioners' Services By Godager, Geir

  1. By: Meliyanni Johar (CHERE, University of Technology, Sydney); Denzil Fiebig; Marion Haas (CHERE, University of Technology, Sydney); Rosalie Viney (CHERE, University of Technology, Sydney)
    Abstract: This study examines behavioural changes brought about by two interventions introduced to lower the incidence of cervical cancer in Australia. The first intervention is a media campaign promoting regular screening behaviour to women. The second intervention is a vaccination program providing a free HPV vaccine, Gardasil, to young women launched in the same period. The results using data from discrete choice experiments find that in general, given individual characteristics, the interventions have minor impact on how women value screening attributes. The interventions however alter womenís inherent taste for screening. Unexpectedly, willingness to screen is generally lower post-interventions. The reason for this trend appears to be related to HPV events. For instance, the reduction in screening participation is particularly marked among young women who are eligible for the vaccination program. There is also a larger aversion towards testing among women who gained information on HPV facts and HPV-related measures. Thus, in the face of HPV innovations, screening promotions need to account for these factors. A simulation exercise is then performed to assess the plausibility of several strategies to increase the screening rate. The results nominate supply-side policies, in particular those targeted to health providers, as the most effective strategy.
    Keywords: cervical screening, HPV Vaccine, preferences, discrete choice experiment, Australia
    JEL: I10
    Date: 2009–06
  2. By: Godager, Geir (Institute of Health Management and Health Economics)
    Abstract: This dissertation consists of empirical essays within the subject of health economics. There are four essays in applied micro-econometrics and, as data in Essays 2 and 4 have a panel format, econometric methods for panel data are applied. Tobit-type models for limited dependent variables are applied in Essays 3 and 4, Nested logit models for choice of general practitioner (GP) are applied in Essay 1 and in Essay 2 modeling and estimation procedures involving latent structural variables are applied. The market for GPs' services is the recurrent theme, and a common feature of the empirical modeling and estimation conducted in the essays of this dissertation is that latent variables play an important role. <p><p> There are several motivations for studying the market for GPs. GPs play a key role and constitute the cornerstone of the health care sector in Norway and other countries with a national health service. The GP is often a patient's first encounter with the health care sector. In Norway the GP also acts as a “gatekeeper”, and a referral from the GP is necessary in order to receive specialized care. Further, decisions made by GPs have a large impact on public spending such as sick-leave benefits and drug reimbursements. Due to this pivotal role of general practice, any research providing policy guidance for the sector will potentially have noticeable welfare effects. <p><p> Studying this market may also provide advances in terms of enhanced understanding of economic behavior in general, and within the discipline of health economics in particular. Arrow's (1963) article describing various imperfections in the market for medical care is often considered to mark the founding of health economics (Culyer and Newhouse, 2000). Many of the peculiarities Arrow describes are, indeed, present in the market for GPs' services. Asymmetric information limits consumer sovereignty and creates challenges for designing appropriate contracts and payment mechanisms. Quality of services is diffcult to observe and quantify, and optimal consumption of health care services is diffcult to achieve. While the general research questions in health economics are relevant in the specific context of general practice, the conditions for knowledge accumulation seem favorable as well. The availability of detailed and disaggregated panel data enables identification and quantification of the mechanisms in focus by applying a large variety of modeling and estimation methods. In addition, one may argue that economic theory is well suited to model individual behavior and that assumptions of rational decision makers are more realistic when describing individuals such as GPs than when describing institutions such as hospitals. Fuchs (2000) describes two related missions of health economists: providing valuable input into health policy and enhancing understanding of economic behavior. Both missions motivate research on the market for GPs. <p><p> Essays 1 and 2 in this dissertation focus mainly on factors influencing the patients' or consumers' decision to seek the services of a particular GP, while Essays 3 and 4 focus on factors influencing the GP's supply decision. The rest of the text proceeds as follows: The next subsection provides a brief introduction to the topic of this dissertation. Summaries of the four essays are given in subsection 1.3. Policy implications of the findings are presented in subsection 1.4. Limitations and ideas for future research are discussed in subsection 1.5. Complete versions of Essays 1-4 follow in sections 2-5. <p> <p>
    Keywords: GP services; discrete choice; willingness-to-pay; health care demand; health care supply; general practice; patient shortage; dual job holding
    JEL: C23 C24 C25 C33 D12 D83 H51 H75 I11 I18 J22
    Date: 2009–09–28

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