Hugh Gravelle1, Stephen Morris, Matt Sutton. 1. National Primary Care Research and Development Centre, Centre for Health Economics, University of York, YO105DD, UK. hg8@york.ac.uk
Abstract
OBJECTIVE: To investigate the impact of family physician (FP) supply on individual health, adjusting for factors that affect both health and FPs' choice of location. STUDY POPULATION: A total of 49,541 individuals in 351 English local authorities (LAs). DATA SOURCES: Data on individual health and personal characteristics from three rounds (1998, 1999, and 2000) of the Health Survey for England were linked to LA data on FP supply. STUDY DESIGN: Three methods for analyzing self-reported health were used. FP supply, instrumented by house prices and by age-weighted capitation payments for patients on FP lists, was included in individual-level health regressions along with individual and LA covariates. RESULTS: When no instruments are used FPs have a positive but statistically insignificant effect on health. When FP supply is instrumented by age-related capitation it has markedly larger and statistically significant effects. A 10 percent increase in FP supply increases the probability of reporting very good health by 6 percent. CONCLUSION: After allowing for endogeneity, an increase in FP supply has a significant positive effect on self-reported individual health.
OBJECTIVE: To investigate the impact of family physician (FP) supply on individual health, adjusting for factors that affect both health and FPs' choice of location. STUDY POPULATION: A total of 49,541 individuals in 351 English local authorities (LAs). DATA SOURCES: Data on individual health and personal characteristics from three rounds (1998, 1999, and 2000) of the Health Survey for England were linked to LA data on FP supply. STUDY DESIGN: Three methods for analyzing self-reported health were used. FP supply, instrumented by house prices and by age-weighted capitation payments for patients on FP lists, was included in individual-level health regressions along with individual and LA covariates. RESULTS: When no instruments are used FPs have a positive but statistically insignificant effect on health. When FP supply is instrumented by age-related capitation it has markedly larger and statistically significant effects. A 10 percent increase in FP supply increases the probability of reporting very good health by 6 percent. CONCLUSION: After allowing for endogeneity, an increase in FP supply has a significant positive effect on self-reported individual health.
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