Health Care Management Science

, Volume 9, Issue 1, pp 5–18 | Cite as

When do people visit a doctor?



We examine the length of time between when an individual feels sick and when he/she visits a doctor using survival analysis to capture the dynamic aspects of this behavior. If the disease is light, actions such as OTC medicine or sick leave are alternatives to visiting a clinic or a hospital immediately. The timing of the visit depends only the person's decision, not on a doctor's, so we can limit discussion to the effect of ex-post moral hazard excluding physician induced demand. Participants were asked to keep a log of illness-related behavior such as dates of episodes, subjective symptoms, sick leaves, and medical treatment at hospitals. Neither the copayment rate nor access cost had a significant effect on the behavior of visiting a doctor, whereas available alternatives delay the timing of a visiting. Severe symptoms and fever hastened the time. The results suggest that the traditional argument about ex-post moral hazard is somewhat misleading.


Health care demand Ex-post moral hazard Copayment rate Survival analysis 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Newhouse JP (1993) Free for All? - Lessons from the Rand Health Insurance Experiment (Harvard University Press, Cambridge).Google Scholar
  2. 2.
    Pohlmeier W, Uhrich V (1995) “An econometric model of the two-part decision-making process in the demand of health care” Journal of Human Resources 30(2): 339–361.Google Scholar
  3. 3.
    Puig-Junoy J, Saez M, Martinez-Garcia E (1998) Why do patients prefer hospital emergency visits? A nested multinomial logit analysis for patient-initiated contacts Health Care Management Science 1: 39–52Google Scholar
  4. 4.
    Gertler P, Locay L, Sanderson W (1987) Are user fees regressive? The welfare implications of health care financing proposals in Peru. Journal of Econometrics 36: 67–88CrossRefGoogle Scholar
  5. 5.
    Gilleskie D (1998) A dynamic stochastic model of medical care use and work absence. Econometrica 66(1): 1–45.Google Scholar
  6. 6.
    Bessho S, Ohkusa Y (2003) What determine hospital choice?: Time cost, option demand, and communication mimeoD.Google Scholar
  7. 7.
    Nagase K (1935) Accident and Sickness Statistics, (Kenko Hoken Ihosha, Tokyo) (in Japanese)Google Scholar
  8. 8.
    Ii M, Ohkusa Y (2002) Economic Analysis of Medical Care Service, (Nihon Keizai Shimbunsha, Tokyo). (in Japanese)Google Scholar
  9. 9.
    Evans WN, Levy H, Simon KI (2000) Research data in health economics. Journal of Economic Perspectives 14(4): 203–216Google Scholar
  10. 10.
    Zweifel P, Manning WG (2000) Moral hazard and consumer incentives in health care, Handbook of Health Economics. Volume 1A, A. J. Culyer and J. P. Newhouse (eds.), (Elsevier Science, Amsterdam)Google Scholar
  11. 11.
    Santos S, Joao MC, Windmeijer F (2001) Two-part multiple spell models for health care demand. Journal of Econometrics 104: 67–89Google Scholar
  12. 12.
    Deb P, Holmes AM (2000) Estimates of use and costs of behavioural health care: A comparison of standard and finite mixture models. Health Economics 9: 475–489CrossRefGoogle Scholar
  13. 13.
    Nakahishi S (2000) Consumer behavior of medical care demand: Estimation of the dynamic demand function. Japanese Journal of Health Economics and Policy 7: 65–76. (in Japanese)Google Scholar
  14. 14.
    Sawano K (2000) Co-payment, coinsurance rate and the elderly care in Japan. Journal of Health Care and Society 10(2): 115–138. (in Japanese).Google Scholar
  15. 15.
    Ii M, Ohkusa Y (2002) Price sensitivity of the demand for medical services for minor ailments: econometric estimates using information on illnesses and symptoms Japanese Economic Review 53(2): 154–166Google Scholar
  16. 16.
    Ii M, Ohkusa Y (2002) Should the coinsurance rate be increased in the case of common cold? An analysis based on an original survey, Journal of the Japanese and International Economies 16: 1–19CrossRefGoogle Scholar
  17. 17.
    Yoshida A, Takagi S (2002) Effects of the reform of the social medical insurance system in Japan. Japanese Economic Review 53(4): 444–465Google Scholar
  18. 18.
    Wooldridge JM (2002) Econometric Analysis of Cross Section and Panel Data (MIT Press, Cambridge)Google Scholar
  19. 19.
    Kiefer NM (1988) Economic duration data and hazard functions. Journal of Economic Literature 26(2): 646–679Google Scholar
  20. 20.
    Lancaster T 1990 The Econometric Analysis of Transition Data, (Cambridge University Press, Cambridge).Google Scholar
  21. 21.
    Hosmer DW, Lemeshow S (1999) Applied Survival Analysis: Regression Modeling of Time to Event Data, (John Wiley & Sons).Google Scholar
  22. 22.
    Gilleskie DB, Mroz TA (2000) Estimating the effects of covariates on health expenditures. NBER Working Paper Series 7942.Google Scholar
  23. 23.
    Acton JP (1975) Nonmonetary factors in the demand for medical services: Some empirical evidence, Journal of Political Economy 83(3): 595–614Google Scholar
  24. 24.
    Grossman M (1972) On the concept of health capital and the demand for health. Journal of Political Economy 80(2): 223–255Google Scholar
  25. 25.
    Smith JP (1999) Healthy bodies and thick wallets: The dual relation between health and economic status. Journal of Economic Perspectives 13(2): 145–166Google Scholar

Copyright information

© Springer Science + Business Media, Inc. 2006

Authors and Affiliations

  1. 1.Graduate School of EconomicsThe University of TokyoTokyo
  2. 2.Infectious Disease Surveillance CenterNational Institute of Infectious DiseasesJapan

Personalised recommendations