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Do measures of self-reported morbidity bias the estimation of the determinants of health care utilisation?

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  • Sutton, Matthew
  • Carr-Hill, Roy
  • Gravelle, Hugh
  • Rice, Nigel

Abstract

Most national surveys of health care utilisation capture only self-reported measures of morbidity. If self-reported morbidity is measured with error, then the results of applied work may be misleading. In this paper we propose a model of the relationship between morbidity and health service utilisation which allows for reporting errors and simultaneity. Errors in self-reported morbidity are expressed as a function of person-specific reporting thresholds and recent contact with health services, arising because of better self-evaluation of current health status or a desire to justify consumption of a publicly-provided good. We demonstrate the bias in ignoring the potential problems of reporting errors and simultaneity for a variety of special cases, but in the general case the biases are of ambiguous sign. The empirical nature of these biases is investigated using limiting long-standing illness (LLI) and recent contact with a General Practitioner (GP) in two waves of The UK Health and Lifestyle Survey. Biomedical measures of functioning are used as objective indicators of health status. We find evidence of substantial and significant differences between individuals in reporting thresholds and some evidence that the reporting of LLI may depend on recent visits to a GP. Adjustments for these biases significantly increase the estimated effect of morbidity on utilisation.

Suggested Citation

  • Sutton, Matthew & Carr-Hill, Roy & Gravelle, Hugh & Rice, Nigel, 1999. "Do measures of self-reported morbidity bias the estimation of the determinants of health care utilisation?," Social Science & Medicine, Elsevier, vol. 49(7), pages 867-878, October.
    • Handle: RePEc:eee:socmed:v:49:y:1999:i:7:p:867-878
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    Citations

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    Cited by:

    1. Matthew Jowett & Anil Deolalikar & Peter Martinsson, 2004. "Health insurance and treatment seeking behaviour: evidence from a low‐income country," Health Economics, John Wiley & Sons, Ltd., vol. 13(9), pages 845-857, September.
    2. Sato, Azusa, 2012. "Do Inequalities in Health Care Utilization in Developing Countries Change When We Take into Account Traditional Medicines?," World Development, Elsevier, vol. 40(11), pages 2275-2289.
    3. Teresa Bago d'Uva, 2005. "Latent class models for use of primary care: evidence from a British panel," Health Economics, John Wiley & Sons, Ltd., vol. 14(9), pages 873-892, September.
    4. Tianhui Chen & Lu Li, 2009. "Influence of health-related quality of life on health service utilization in addition to socio-demographic and morbidity variables among primary care patients in China," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 54(5), pages 325-332, October.
    5. Laudicella, Mauro & Cookson, Richard & Jones, Andrew M. & Rice, Nigel, 2009. "Health care deprivation profiles in the measurement of inequality and inequity: An application to GP fundholding in the English NHS," Journal of Health Economics, Elsevier, vol. 28(6), pages 1048-1061, December.
    6. Richard Cookson & Mark Dusheiko & Geoffrey Hardman, 2006. "Socio-economic inequality in small area use of elective total hip replacement in the English NHS in 1991 and 2001," Working Papers 015cherp, Centre for Health Economics, University of York.
    7. Pat McGregor & Pat McKee & Ciaran O’Neill, 2006. "GP Utilisation in Northern Ireland - Exploiting the Gatekeeper Function," The Economic and Social Review, Economic and Social Studies, vol. 37(1), pages 71-90.
    8. Longden, Thomas & Wong, Chun Yee & Haywood, Philip & Hall, Jane & van Gool, Kees, 2018. "The prevalence of persistence and related health status: An analysis of persistently high healthcare costs in the short term and medium term," Social Science & Medicine, Elsevier, vol. 211(C), pages 147-156.
    9. Alessio Petrelli & Roberta Picariello & Giuseppe Costa, 2010. "Toward a needs based mechanism for capitation purposes in Italy: the role of socioeconomic level in explaining differences in the use of health services," International Journal of Health Economics and Management, Springer, vol. 10(1), pages 29-42, March.
    10. 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.
    11. Tavares, Lara Patrício & Zantomio, Francesca, 2017. "Inequity in healthcare use among older people after 2008: The case of southern European countries," Health Policy, Elsevier, vol. 121(10), pages 1063-1071.
    12. Burstrom, Bo, 2002. "Increasing inequalities in health care utilisation across income groups in Sweden during the 1990s?," Health Policy, Elsevier, vol. 62(2), pages 117-129, November.
    13. Thomson, Michael, 2019. "Who had access to doctors before and after new universal capitated subsidies in New Zealand?," Health Policy, Elsevier, vol. 123(8), pages 756-764.
    14. Laura Vallejo-Torres & Stephen Morris, 2011. "Factors associated with the use of primary care services: the role of practice nurses," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(4), pages 373-381, August.
    15. Vallejo-Torres, Laura & Morris, Stephen & Carr-Hill, Roy & Dixon, Paul & Law, Malcom & Rice, Nigel & Sutton, Matthew, 2009. "Can regional resource shares be based only on prevalence data? An empirical investigation of the proportionality assumption," Social Science & Medicine, Elsevier, vol. 69(11), pages 1634-1642, December.
    16. Carol Propper & Jenny Eachus & Philip Chan & Nicky Pearson & George Davey Smith, 2005. "Access to health care resources in the UK: the case of care for arthritis," Health Economics, John Wiley & Sons, Ltd., vol. 14(4), pages 391-406, April.
    17. M.D. Azharuddin Akhtar & Nadeem Ahmad & Indrani Roy Chowdhury, 2020. "Measuring Socio-Economic Inequality in Self-Reported Morbidity in India: Decomposition Analysis," Review of Development and Change, , vol. 25(1), pages 89-111, June.

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