Venue: The Fuqua School of Business, Duke University, 1 Towerview Drive, Durham, NC 27708-0120
Presentation
The income - health care utilization gradient: Is it causal?
The combat of inequities in health care utilization is highly prioritized in many developed countries. Yet, most of the literature has addressed how to test for inequity and to construct summary measures of income-related inequality. Little is known about the causal relation between income and health care utilization. This study uses highly reliable Danish register data observed over a ten years period to infer the causal impact of disposable income on General Practitioner visits. Using Poisson regressions to adjust for socio-demographics and health indicators, we observe a significant effect of income gradient on General Practitioner visits. However, it has a clear kink in the sense that those with very low income make least use of the health care system. We use various identification schemes to infer whether these income-related differences are causal. This includes fixed effect Poisson estimates and local tax changes as instrumental variable for income. Furthermore, income transfer reforms in 2002 and 2004 that substantially lowered income transfers for certain groups are also applied to identify the impact of income.