Specification and Simulated Likelihood Estimation of a Non-Normal Treatment-Outcome Model with Selection: Application to Health Care Utilization

We develop a specification and estimation framework for a class of nonlinear, non-normal microeconometric models of treatment and outcome with selection. A latent factor structure is used to accommodate selection into treatment and a simulated likelihood method is used for estimation. The methodology is applied to examine the causal effect of managed care, a multinomial discrete choice process, on the utilization of health care services, measured as binary indicators and counts. The results indicate that there are significant unobserved self-selection effects and these effects substantially change the estimated effects of insurance on utilization. Copyright Royal Economic Society 2006

[1]  Michael Keane,et al.  A Note on Identification in the Multinomial Probit Model , 1992 .

[2]  S. Ettner,et al.  Adverse selection and the purchase of Medigap insurance by the elderly. , 1997, Journal of health economics.

[3]  M. Lechner.  Program Heterogeneity and Propensity Score Matching: An Application to the Evaluation of Active Labor Market Policies , 2002, Review of Economics and Statistics.

[4]  I Hendel,et al.  Asymmetric information in health insurance: evidence from the National Medical Expenditure Survey. , 2001, The Rand journal of economics.

[5]  K. Train,et al.  Forecasting new product penetration with flexible substitution patterns , 1998 .

[6]  T. Mroz,et al.  Discrete factor approximations in simultaneous equation models: estimating the impact of a dummy endogenous variable on a continuous outcome. , 1999, Journal of econometrics.

[7]  B. Lindsay.  Mixture models : theory, geometry, and applications , 1995 .

[8]  Thomas G McGuire,et al.  Service-level selection by HMOs in Medicare. , 2003, Journal of health economics.

[9]  George Farkas,et al.  Endogenous Covariates in Duration Models and the Effect of Adolescent Childbirth on Schooling , 1989 .

[10]  Huw T. O. Davies.  The Economic Evolution of American Health Care: From Marcus Welby to Managed Care , 2003 .

[11]  Mark R. Rosenzweig,et al.  Estimating the Intrahousehold Incidence of Illness: Child Health and Gender-Inequality in the Allocation of Time , 1990 .

[12]  Donna B. Gilleskie,et al.  A flexible approach for estimating the effects of covariates on health expenditures. , 2000, Journal of health economics.

[13]  Steven P. Cassou,et al.  Health Plan Choice and the Utilization of Health Care Services , 1991 .

[14]  Jacob Glazer,et al.  Measuring Adverse Selection in Managed Health Care , 1998, Journal of health economics.

[15]  Joseph V. Terza,et al.  Estimating count data models with endogenous switching: Sample selection and endogenous treatment effects , 1998 .

[16]  S. Crystal,et al.  Uninsured status and out-of-pocket costs at midlife. , 2000, Health services research.

[17]  J. Heckman,et al.  Policy-Relevant Treatment Effects , 2001 .

[18]  James E. Prieger,et al.  A flexible parametric selection model for non‐normal data with application to health care usage , 2002 .

[19]  S D Hosek,et al.  The effects of benefit design and managed care on health care costs. , 1995, Journal of health economics.

[20]  Donald Kenkel,et al.  The effect of physician advice on alcohol consumption: count regression with an endogenous treatment effect , 2001 .

[21]  Jeffrey A. Dubin,et al.  An Econometric Analysis of Residential Electric Appliance Holdings and Consumption , 1984 .

[22]  Sally C Stearns,et al.  Do Medicare HMOs still reduce health services use after controlling for selection bias? , 2002, Health economics.

[23]  D. Hyslop,et al.  State dependence, serial correlation and heterogeneity in intertemporal labor force , 1999 .

[24]  D. McFadden,et al.  MIXED MNL MODELS FOR DISCRETE RESPONSE , 2000 .

[25]  Satishs Iyengar,et al.  Multivariate Models and Dependence Concepts , 1998 .

[26]  A. Hillman,et al.  How do financial incentives affect physicians' clinical decisions and the financial performance of health maintenance organizations? , 1989, The New England journal of medicine.

[27]  Peter Kemper,et al.  Insurance Product Design and its Effects: Trade-offs along the Managed Care Continuum , 2002, Inquiry : a journal of medical care organization, provision and financing.

[28]  R H Miller,et al.  A reply to Sullivan's reanalysis of managed care plan performance since 1980. , 2000, American journal of public health.

[29]  D. Goldman,et al.  Managed care as a public cost-containment mechanism. , 1995, The Rand journal of economics.

[30]  J. Angrist,et al.  Identification and Estimation of Local Average Treatment Effects , 1995 .

[31]  D. McFadden.  Econometric Models for Probabilistic Choice Among Products , 1980 .

[32]  Jonathan Gruber,et al.  Tax Subsidies for Health Insurance: Evaluating the Costs and Benefits , 2000 .

[33]  Lung-fei Lee.  Generalized Econometric Models with Selectivity , 1983 .

[34]  Donna B. Gilleskie,et al.  A Dynamic Stochastic Model of Medical Care Use and Work Absence , 1998 .

[35]  J. Heckman,et al.  Making the Most out of Programme Evaluations and Social Experiments: Accounting for Heterogeneity in Programme Impacts , 1997 .

[36]  C. Bhat.  Quasi-random maximum simulated likelihood estimation of the mixed multinomial logit model , 2001 .

[37]  G. Maddala.  Limited-dependent and qualitative variables in econometrics: Introduction , 1983 .

[38]  J J Toland,et al.  Managed care. , 1995, Orthopedics.

[39]  Ian Walker,et al.  Household unemployment and the labour supply of married women , 1997 .

[40]  Hans van Ophem,et al.  Modeling Selectivity in Count-Data Models , 2000 .

[41]  P. Schmidt,et al.  Limited-Dependent and Qualitative Variables in Econometrics. , 1984 .

[42]  D. Bartholomew.  Latent Variable Models And Factor Analysis , 1987 .

[43]  Tom Wansbeek,et al.  Identification, Equivalent Models, and Computer Algebra , 1994 .

[44]  Eric R. Jensen.  An Econometric Analysis of the Old-Age Security Motive for Childbearing , 1990 .

[45]  Robert H. Miller,et al.  Managed care plan performance since 1980. A literature analysis. , 1994, JAMA.

[46]  Raquel Carrasco,et al.  Binary Choice with Binary Endogenous Regressors in Panel Data: Estimating the Effect of Fertility on Female Labor Participation , 1998 .

[47]  H. White.  Maximum Likelihood Estimation of Misspecified Models , 1982 .

[48]  Anne Digby.  The economic evolution of American health care: from Marcus Welby to managed care , 2002, Medical History.

[49]  A. Cameron,et al.  A Microeconometric Model of the Demand for Health Care and Health Insurance in Australia , 1988 .

[50]  G. Gowrisankaran,et al.  Estimating the quality of care in hospitals using instrumental variables. , 1999, Journal of health economics.