ANALYSIS WITH NESTED MULTINOMIAL LOGIT MODEL OF DEMAND FOR HEALTHCARE: AN APPLICATION IN KAYSERI PROVINCE

Abstract

Determining the factors affecting the demand for healthcare services are important in terms of providing health services more effectively and a more efficient health system. In addition, effective provision of healthcare services is an important element in terms of basic socio-economic development of countries. The primary aim of this study is to determine the factors which affect the demand for healthcare services. In that framework, factors related to household’s choice of applying to a healthcare facility because of a health problem and the factors related to household’s healthcare facility choice are investigated using the data collected in Kayseri province with survey method. Within the scope of the study, Nested Logit Model was implemented to the data set using Full Information Maximum Likelihood (FIML) technique which estimates both decision levels simultaneously. According to the results obtained, the factors which affect the choice of applying to the healthcare facility were found as the educational level of the household head, severity of the disease and some health problem complaints. Among the factors which affect healthcare facility choice, educational level of the patient reduces the likelihood of applying to both public and private healthcare facilities. Furthermore, likelihood of applying to public healthcare facilities reduces with the age of the patient.

Keywords

• Health,Demand for Healthcare,Discrete Choice Models,Choice Models,Nested Multinomial Logit Model,Kayseri,Turkey

SAĞLIK HİZMETLERİ TALEBİNİN NESTED MULTİNOMİNAL LOGİT MODEL İLE ANALİZİ: KAYSERİ İLİNDE BİR UYGULAMA

Abstract

Sağlık hizmetleri talebini etkileyen faktörlerin belirlenmesi sağlık hizmetlerinin daha etkin sunulması ve daha verimli işleyen bir sağlık sistemi açısından önemlidir. Ayrıca sağlık hizmetlerinin etkin sunumu ülkelerin temel sosyo-ekonomik gelişimleri açısından da önemli bir unsurdur.  Bu çalışmada temel amaç sağlık hizmetlerine olan talebi etkileyen faktörleri belirlemektir. Bu çerçevede Kayseri ilinde anket yöntemi ile toplanan veriler kullanılarak, hanehalkının bir sağlık problemine bağlı olarak sağlık kuruluşuna başvuru tercihi ile ilişkili faktörler ve sağlık kuruluşu tercihleri ile ilişkili faktörler incelenmiştir. Veri seti Kayseri ilinde hanehalkı anket uygulaması ile oluşturulmuştur. Çalışma kapsamında veri setine her iki karar seviyesini aynı anda tahmin eden tam bilgiye dayalı maksimum olabilirlik (FIML) tekniği kullanılarak Nested Multinominal Logit Model uygulanmıştır. Elde edilen sonuçlara göre sağlık kuruluşuna başvuru tercihini etkileyen faktörler olarak hanehalkı reisinin eğitim seviyesi, hastalık şiddeti ve bazı sağlık problemi şikayetleri bulunmuştur. Sağlık kuruluşu tercihini etkileyen faktörlerden hastanın eğitim seviyesi hem kamu hem de özel sağlık kuruluşuna başvurma olasılığını azaltmaktadır. Ayrıca kamu sağlık kuruluşlarına başvurma olasılığı hastanın yaşı ile birlikte azalmaktadır.

Keywords

• Sağlık,Sağlık Hizmetleri Talebi,Kesikli Tercih Modelleri,Nested Multinominal Logit Model,Kayseri,Turkey

References

1. REFERENCESBörsch Supan, A. (2012), Econometric Analysis of Discrete Choice: With Applications on the Demand for Housing in the U.S. and West Germany, Springer Science & Business Media, 296.Carrasco, JA,, Ortuzar, JdD. (2002), Review and Assesment of The Nested Logit Model. Transport Reviews, 22(2), 197-218. Cisse, A. (2006), Analysis of Health Care Utilization in Cote d'Ivoire. Research Paper, Report No: 201.Feldstein, Paul J. (1966), Research On The Demand For Health Services, The Milbank Memorial Fund Quarterly, 44(3), 128-165.Fuchs, V. R. (1972), Essays In The Economics Of Health And Medicalcare, NBER Books.Grossman, M. (1972), On The Concept Of Health Capital And The Demand For Health, Journal of Political Economy, 80(2), 223-255.Guda, A. (2001), Challenges of Healthcare Financing: Economic and Welfare Effect of User Fees in Urban Ethiopia.Ethiopia: Addis Ababa University.Hensher, DA., Rose, JM., Greene, WH. (2005), Applied Choice Analysis: A Primer, Cambridge University Press.Ichoku, EH,, Leibbrandt, M.(2003), Demand for Healthcare Services in Nigeria: A Multivariate Nested Logit Model, African Development Review, 15(2-3),396-424.Jack, W. (1999), Principles Of Health Economics For Developing Countries. World Bank Publications.Kermani, MS., Ghaderi, H., Yousefi, A. (2008), Demand for Medical Care in The Urban Areas of Iran: An Empirical Investigation, Health Economics, 17(7), 849-862.Koppelman, FS., Bhat, C. (2006), A self Instructing Course in Mode Choice Modeling: Multinomial and Nested Logit Models, U.S. Department of Transportation Federal Transit Administration.Lindelow, M. (2003), Understanding Spatial Variation in The Utilization of Health Sevices: Does Quality Matter? The World Bank, Centre for Study of African Economies.Muriithi, MK. (2013), The Determinants of Health-Seeking Behavior in A Nairobi Slum: The Role of Quality and Information, European Scientific Journal, 9(8).Özkoç, H.(2013), Hastaların Sağlık Kurumu Tercihlerini Etkileyen Faktörlerin Belirlenmesi: Uygunluk Analizi ve Nested Logit Model, Dokuz Eylül Üniversitesi Sosyal Bilimler Enstitüsü Dergisi, 15(2), 267-280.Phelps, C. (1992), Health Economics. Harper Collins Publishers: New York.Qian, D., Raymond, PW., Yin, A., Nagarajan, KV., Qingyue, M.(2010), Determinants of Health Care Demand in Poor Rural China: The Case of Gansu Province, Health Policy and Planning, 24(5), 324-334.Sarma, S. K. (2003), Demand For Outpatient Health Care in Rural India: A Nested Multinomial Logit Approach. University of Manitoba.Sarma, S.(2009), Demand for Outpatient Healthcare, Applied Health Economics and Health Policy, 7(4), 265-277.Silberhorn, N., Boztuğ, Y., Hildebrandt, L.(2007), Price and Income Elasticities of Demand for Modern Health Care: The case of Infant Delivery in The Philippines, The World Bank Economic Review, 2(1), 49-76.