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Does free choice of hospital conflict with equity of access to highly specialized hospitals? A case study from the Danish health care system

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  • Tayyari Dehbarez, Nasrin
  • Gyrd-Hansen, Dorte
  • Uldbjerg, Niels
  • Søgaard, Rikke

Abstract

Equity of access to health care is a central objective of European health care systems. In this study, we examined whether free choice of hospital, which has been introduced in many systems to strengthen user rights and improve hospital competition, conflicts with equity of access to highly specialized hospitals. We chose to carry out a study on 134,049 women who had uncomplicated pregnancies from 2005 to 2014 in Denmark because of their homogeneity in terms of need, the availability of behavioral data, and their expected engagement in choice of hospital. Multivariate logistic regression was used to link the dependent variable of bypassing the nearest non-highly specialized public hospital in order to “up-specialize”, with independent variables related to socioeconomic status, risk attitude, and choice premises, using administrative registries. Overall, 16,426 (12%) women were observed to bypass the nearest hospital to up-specialize. Notably, high education level was significantly associated with up-specialization, with an odds ratio of 1.50 (95% CI: 1.40–1.60, p < 0.001) compared to low education group. This confirms our hypothesis that there is a socioeconomic gradient in terms of exercising the right to a free choice of hospital, and so the results indicate that the policy exacerbates inequity of access to health care.

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  • Tayyari Dehbarez, Nasrin & Gyrd-Hansen, Dorte & Uldbjerg, Niels & Søgaard, Rikke, 2018. "Does free choice of hospital conflict with equity of access to highly specialized hospitals? A case study from the Danish health care system," Health Policy, Elsevier, vol. 122(7), pages 722-727.
    • Handle: RePEc:eee:hepoli:v:122:y:2018:i:7:p:722-727
    DOI: 10.1016/j.healthpol.2018.04.006
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    1. van der Pol, Marjon & Ruggeri, Matteo, 2008. "Is risk attitude outcome specific within the health domain?," Journal of Health Economics, Elsevier, vol. 27(3), pages 706-717, May.
    2. Waters, Hugh R., 2000. "Measuring equity in access to health care," Social Science & Medicine, Elsevier, vol. 51(4), pages 599-612, August.
    3. Timothy Besley & Maitreesh Ghatak, 2003. "Incentives, Choice, and Accountability in the Provision of Public Services," Oxford Review of Economic Policy, Oxford University Press and Oxford Review of Economic Policy Limited, vol. 19(2), pages 235-249, Summer.
    4. Wagstaff, Adam & van Doorslaer, Eddy, 2000. "Chapter 34 Equity in health care finance and delivery," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 34, pages 1803-1862, Elsevier.
    5. Morris, Stephen & Sutton, Matthew & Gravelle, Hugh, 2005. "Inequity and inequality in the use of health care in England: an empirical investigation," Social Science & Medicine, Elsevier, vol. 60(6), pages 1251-1266, March.
    6. Vrangbæk, Karsten & Østergren, Katarina, 2006. "Patient empowerment and the introduction of hospital choice in Denmark and Norway," Health Economics, Policy and Law, Cambridge University Press, vol. 1(4), pages 371-394, October.
    7. Goddard, Maria & Smith, Peter, 2001. "Equity of access to health care services: : Theory and evidence from the UK," Social Science & Medicine, Elsevier, vol. 53(9), pages 1149-1162, November.
    8. Allison B. Rosen & Jerry S. Tsai & Stephen M. Downs, 2003. "Variations in Risk Attitude across Race, Gender, and Education," Medical Decision Making, , vol. 23(6), pages 511-517, November.
    9. Giuseppe Moscelli & Luigi Siciliani & Nils Gutacker & Richard Cookson, 2015. "Socioeconomic Inequality of Access to Healthcare: Does Patients' Choice Explain the Gradient? Evidence from the English NHS," Working Papers 112cherp, Centre for Health Economics, University of York.
    10. Vrangbæk, Karsten & Østergren, Katarina & Birk, Hans Okkels & Winblad, Ulrika, 2007. "Patient reactions to hospital choice in Norway, Denmark, and Sweden," Health Economics, Policy and Law, Cambridge University Press, vol. 2(2), pages 125-152, April.
    11. Takanori Ida & Rei Goto, 2009. "Simultaneous Measurement Of Time And Risk Preferences: Stated Preference Discrete Choice Modeling Analysis Depending On Smoking Behavior," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 50(4), pages 1169-1182, November.
    12. Culyer, A. J. & Wagstaff, Adam, 1993. "Equity and equality in health and health care," Journal of Health Economics, Elsevier, vol. 12(4), pages 431-457, December.
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