Overview

Abstract (English)

It is well known that understanding the underlying process of the demand for health and health care utilization is crucial for a better assessment of the role of public intervention in the health sector. This thesis explores several theoretical and empirical aspects of these issues using unexplored and unique data sets, an appropriate economic theoretical framework and advanced economic techniques. Essay I examines the factors determining the utilization of different types of health care from recent canadian National Population Health Survey conducted by Statistics Canada. It uses the number of visits to GPs, specialists, and dentists and the number of nights spent in hoqpital as measures of utilization of health care. An intuitively appealing economic framework in which individuals maximize the net benefits of visits, is used to base the analysis of health care utilization. The most striking results from this paper are that supplemental health insurance increases outpatient health visits, that there is vertical equlty in the utilization of health care and that there are some indications of supplier induced demand for health care. It is also found that that ex ante and ex post utilization are two distinct stochastic processes. Essay 2 examines the issues relating to demand for healthcare in rural India where much of the health services are typically provided at little or no monetary cost. This essay uses a discrete choice model to explain the underlying determinants of the demand for outpatient health care in rural India based on National Sample Survey (NSS) data for the first time. As opposed to fixed choice sets used in the literature, a variable choice set is constricted and used in this study to reflect the true choice generating process as close as possible. The relevant price data for unchosen alternatives in the choice set are imputed. The paper discusses econometric methods relating to identification, scaling, invariance, and consistency with the utility maximization hypothesis that underlies the basis of modelling health care demand. Contrary to many earlier studies on the demand for health care in developing countries, prices and income are found to be statistically significant determinants of health care choice. Distance is a pronounced inhibiting factor in the demand for outpatient health care in rural India. Linking Aging ln Manitoba (AIM) longitudinal study on l97l cohort’s interview data with home care admission data essay 3 explores the underlying determinants of elderly living arrangements. It is found that home care admission (ex ante home care utilization) reduces the demand for nursing home and increases the demand for independent living. Loss of a spouse affects independent living negatively and both cohabiting and nursing home residence positively. The effect of age on nursing home residence is positive and on independent living and cohabiting is negative. Educated people are more likely to live independently than cohabit or enter an institution. Similarly, those who are healthy and satisfied in life are more likely to live independently instead of cohabiting or entering nursing homes. Those who lived longer in the community are more likely to live independently or cohabit rather than enter an institution. Home ownership is positively associated with both independent living and cohabiting. The results are suggestive of possible income related inequity in institutionalization.

Abstract (French)

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