An Investigation of Medical Expenditures in Hospitals and Clinics Using Propensity Scores

Abstract

This study identifies the factors affecting people’s attitudes toward hospital use and measures the impact of people’s attitudes toward healthcare services on out-of-pocket healthcare expenditures using the data from an original questionnaire survey in Japan. We regard the probability of hospital use as a propensity score in order to remove other impacts on the expenditure except the differences between hospital and clinic users. Our empirical results reveal that the accessibility of healthcare facilities is one of the most important factors affecting people’s behaviors in choosing their primary care provider and that out-of-pocket medical expenditures are irrelevant to whether people choose a hospital or a clinic in Japan.

Appendix: Residential Environment Survey (Including Pension Income)? (Conducted in 2009): Summary

• Q1. What type of house do you reside in?

1) Detached house	2) Tenement house	3) Rental apartment (wooden)
4) Apartment or condominium

• <Additional question for respondents who answer (1) or (2) in Q1>

• AQ1-1. What type of ownership applies to your residential land and housing?

1) Renting land and house	2) Owning a house on leased land
3) Owning land and house

• <Additional question for respondents who answer (4) in Q1>

• AQ1-2. What type of ownership applies to your residence?

1) Renting

2) Owning

$$ \left(\mathrm{Omitted}\right) $$

• Q3. How long have you lived in your current house?

1) Less than one year	2) 1–3 years	3) 3–5 years
4) 5–10 years	5) 10–20 years	6) More than 20 years

$$ \left(\mathrm{Omitted}\right) $$

• Q6. How long does it take from your house to the nearest railway station on foot?

1) Less than 5 min	2) 5–10 min	3) 10–20 min
4) 20–30 min	5) More than 30 min

• Q7. Are there any medical/ healthcare facilities within walking distance (about 10–15 minutes’ walk) from home? If there are any, please fill in the number of facilities.

  • Are there any clinics (without beds) near your house?

1) Yes (number of facilities:  )

2) No

• Are there any medical/healthcare facilities (with beds) near your house?

1) Yes (number of facilities:  )

2) No

• Q8. If you feel sick, what type of medical/healthcare facility (your primary care physician office) do you usually go to?

  • 1) A clinic without beds

  • 2) A small hospital with 20–100 beds and 1–5 clinical departments

  • 3) A medium-sized hospital with 100–500 beds and 5–10 clinical departments

  • 4) A large hospital with over 500 beds and 10–20 clinical departments

• Q9. What transport do you use to get to your primary care . physician office? Please select those that apply in the list below.

1) Walking	2) Bicycle	3) Motorbike/motor scooter
4) Car	5) Taxi	6) Bus	7) Train

• Q10. How long does it take from your house to your primary care physician office?

1) Less than 5 min	2) 5–10 min	3) 10–30 min
4) 30–60 min	5) More than 60 min

• Q11. What are important reasons for choosing a primary care physician office? Please select those that apply in the list below.

1) Proximity to home	2) Proximity to workplace
3) Having good access to transportation	4) Having a kind doctor
5) Having good medical specialists	6) Having a variety of clinical departments
7) Having advanced medical equipment	8) Available within short waiting times
9) Being referred by my GP	10) Having a good reputation
11) Recommended by my friends/acquaintances	12) Other (   )

$$ \left(\mathrm{Omitted}\right) $$

• SQ1. Please identify the characteristics of the respondent.

Gender :	1) Male	2) Female
Age:	1) 20s	2) 30s	3) 40s	4) 50s	5) 60s	7) 70 or over

• SQ2. How many family members do you live with (excluding yourself)? Please fill in the number of members by age.

1) Under 10 years of age	(number of members:  )
2) 10–19 years of age	(number of members:  )
3) 20–29 years of age	(number of members:  )
4) 30–39 years of age	(number of members:  )
5) 40–49 years of age	(number of members:  )
6) 50–59 years of age	(number of members:  )
7) 60–69 years of age	(number of members:  )
8) Over 70 years of age	(number of members:  )

• SQ3. What is the main income source of your household?

  • 1) Wages/salaries (paid to a parson for regular work or services)

  • 2) Income from business/profession

  • 3) Income from immovable property (income received from rental properties)

  • 4) Interest income (earned on public and corporation bonds and/or saving accounts)

  • 5) Dividend income (distribution of earnings to shareholders)

  • 6) Pension income

  • 7) Other (   )

• SQ4. How much is the total annual household income (including pension income)?

1) Less than 2 million yen	2) 2–4 million yen	3) 4–6 million yen
4) 6–8 million yen	5) 8–10 million yen	6) More than 10 million yen

$$ \left(\mathrm{Omitted}\right) $$

• SQ8. How much is the total annual household out-of-pocket medical expenses (excluding orthodontic expenses)?

1) Less than 10 thousand yen	2) 10–30 thousand yen	3) 30–50 thousand yen
4) 50–100 thousand yen	5) 100–150 thousand yen	6) More than 150 thousand yen