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Simultaneous Use of Public and Private Specialist Services as a Potential Strategic Behaviour in Access to the National Health Service: Is There a Pattern by Socio-economic Level?
Social Justice Research ( IF 1.700 ) Pub Date : 2019-03-04 , DOI: 10.1007/s11211-019-00330-y
M. A. Negrín , J. Pinilla , I. Abásolo

Under national health services (NHS), non-urgent access to specialist doctors is not straightforward and sometimes leads to long waiting times. Consequently, some citizens may decide to pay for private specialist care to complement the services provided publicly, trying to shorten their NHS waiting times. This strategic behaviour may lead to inequities in access to public specialist services. A way to approach this phenomenon is to analyse those patients that use private and public specialist care simultaneously. The aim of this paper is to determine the proportion of patients who combine both types of services, their profile and to analyse whether the recent economic crisis has accentuated this phenomenon or not. With survey data from the Spanish Health Barometer between 2005 and 2015, probit models of the probability of combining public and private specialist visits are estimated, controlling for socio-economic, demographic and other individual characteristics. Models are estimated using the Heckman correction technique to solve the potential selection bias problem. Almost one in ten patients who visited a public specialist in the previous year also visited a private specialist. Insofar as these patients have used private specialist care strategically, as complementary services to those of the Spanish NHS, this phenomenon might contribute to generate horizontal inequity in access favouring such individuals, whose profiles respond to a high socio-economic level, young and resident in the regions of Canarias, C. Valenciana, Cataluña, Navarra or Cantabria. With the economic crisis and public budget cuts, the proportion of patients who combine private and public specialist care has declined probably due to the predominance of a “household income effect”.

中文翻译:

同时使用公共和私人专家服务作为获得国家卫生服务的潜在战略行为:社会经济水平是否存在某种模式?

在国家卫生服务(NHS)下,非紧急求助于专科医生并非易事,有时会导致漫长的等待时间。因此,一些公民可能决定为私人提供的私人护理服务付费,以补充公开提供的服务,从而试图缩短他们的NHS等待时间。这种战略行为可能会导致获得公共专业服务的机会不均。解决此现象的一种方法是分析同时使用私人和公共专家护理的那些患者。本文的目的是确定结合两种服务类型的患者比例,个人资料,并分析最近的经济危机是否加剧了这种现象。根据2005年至2015年西班牙健康晴雨表的调查数据,估计了公共和私人专家访问相结合的概率的概率模型,控制了社会经济,人口统计学和其他个人特征。使用Heckman校正技术估计模型以解决潜在的选择偏差问题。在前一年拜访过公共专家的患者中,几乎有十分之一也拜访了私人专家。只要这些患者从战略上使用私人专科护理作为西班牙NHS的补充服务,则这种现象可能会导致在获取方面出现横向不平等,从而有利于这些人,这些人的身分符合较高的社会经济水平,是年轻人和居民卡纳里亚斯,巴伦西亚纳,加泰罗尼亚,纳瓦拉或坎塔布里亚地区。随着经济危机和公共预算的削减,
更新日期:2019-03-04
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