An empirical analysis of the demand for physician services across the European Union

  • Sergi Jiménez-Martín
  • José M. Labeaga
  • Maite Martínez-Granado


This paper presents parameter estimates for physician service equations using the “European Community Household Panel” for 12 countries covering the period 1994–1996. The focus is on two specific points: (1) the identification of behavioural similarities and differences in the demand for health services across the 12 countries; (2) the variability in demand for health services represented through a joint model for all countries. We found that there are significant differences among countries, although there are also similarities in the effect of variables such as health stock, labour situation or family structure. An important fraction of the variability in the demand for health services across countries could be explained by differences in age, income and the role of general practitioners as gatekeepers in the public health system. We found some evidence of induced demand in the decision to visit a specialist and in the number of such visits.


Count data Demand Physician services Latent class model Two-part model 



We are indebted to Raquel Carrasco, Berthold Herrendorf, Andrew Jones, Owen O’Donnell and two anonymous referees for their many helpful comments. This study was supported by an unrestricted educational grant from The Merck Foundation, the philanthropic arm of Merck & Co. Inc. Whitehouse Station, New Jersey, USA and by BEC-2002-04294-C01-C02. All remaining errors are our own.


Keine Angaben


  1. 1.
    Alvarez B (2001) La demanda atendida de consultas médicas y servicios urgentes. Investigaciones Económicas 25:93–138Google Scholar
  2. 2.
    Anderson K, Burkhauser R (1985) The retirement-health nexus: a new measure of an old puzzle. J Hum Res 20:315–330Google Scholar
  3. 3.
    Baltagi BH, Bresson G, Pirotte A (2003) Fixed effects, random effects or Hausman-Taylor? A pretest estimator. Econom Lett 79:361–369CrossRefGoogle Scholar
  4. 4.
    Cameron AC, Trivedi PK (1986) Econometric models based on count data: comparisons and applications of some estimators and tests. J Appl Economet 1:29–53Google Scholar
  5. 5.
    Cameron AC, Trivedi PK (1998) Regression analysis of count data. Cambridge University Press, CambridgeGoogle Scholar
  6. 6.
    Cameron AC, Trivedi PK, Milne F, Piggot J (1988) A microeconometric model of the demand for health care and health insurance in Australia. Rev Econom Stud 55:85–106Google Scholar
  7. 7.
    Cromwell J, Michell J (1986) Physician-induced demand for surgery. J Health Econ 1:293–313CrossRefGoogle Scholar
  8. 8.
    Deb P, Holmes AM (2000) Estimates of use and costs of behavioural health care: a comparison of standard and finite mixture models. Health Econ 9:475–489CrossRefPubMedGoogle Scholar
  9. 9.
    Deb P, Trivedi PK (1997) Demand for medical care by the elderly in the United States: a finite mixture approach. J Appl Economet 12:313–336CrossRefGoogle Scholar
  10. 10.
    Deb P, Trivedi PK (2002) The structure of demand for health care: latent class versus two-part models. J Health Econ 201:601–625CrossRefGoogle Scholar
  11. 11.
    Grossman M (1972) The demand for health—a theoretical and empirical investigation. Columbia University Press, New YorkGoogle Scholar
  12. 12.
    Grytten J, Sørensen RR (2001) Type of contract and supplier-induced demand for supplementary dental insurance. J Health Econ 20:379–398CrossRefPubMedGoogle Scholar
  13. 13.
    Heckman JJ, Singer B (1984) A method of minimizing the distributional impact in econometric models for duration data. Econometrica 52:271–320Google Scholar
  14. 14.
    Jiménez-Martín S, Labeaga JM, Martínez-Granado M (2000) An empirical analysis of the demand for health using the European Community Household Panel, WP 00/67. Universidad Carlos III de Madrid, MadridGoogle Scholar
  15. 15.
    Jiménez-Martín S, Labeaga JM, Martínez-Granado M (2002) Latent class versus two-part models in the demand for physician services across the European Union. Health Econ 11:301–321CrossRefPubMedGoogle Scholar
  16. 16.
    Kenkel DS (1990) Consumer health information and the demand for medical care. Rev Econ Stat 22:587–595Google Scholar
  17. 17.
    Moulton BR (1986) Random group effects and the precision of regression estimates. J Economet 32:385–397CrossRefGoogle Scholar
  18. 18.
    Moulton BR (1990) An illustration of a pitfall in estimating the effects of aggregate variables on micro units. Rev Econ Stat 72:334–338Google Scholar
  19. 19.
    Mullahy J (1986) Specification and testing of some modified count data models. J Economet 33:341–365CrossRefGoogle Scholar
  20. 20.
    Peracchi F (2000) The European Community Household Panel: a review. Empir Econ 27:63–90CrossRefGoogle Scholar
  21. 21.
    Pohlmeier W, Ulrich V (1995) An econometric model of the two-part decision making in the demand for health care. J Hum Res 30:339–361Google Scholar
  22. 22.
    Propper C (2000) The demand for private health care in the UK. J Health Econ 19:855–876CrossRefPubMedGoogle Scholar
  23. 23.
    Santos-Silva JMC, Windmeijer F (1997) Endogeneity in count data models: an application to demand for health care. J Appl Economet 12:281–294CrossRefGoogle Scholar
  24. 24.
    Santos-Silva JMC, Windmeijer F (2001) Two-part multiple spell models for health care demand. J Econom 104:67–89CrossRefGoogle Scholar
  25. 25.
    Sudman S, Bradburn N, Schwarz N (1996) Thinking about answers: the application of cognitive processes to survey methodology. Jossey-Bass, San FranciscoGoogle Scholar
  26. 26.
    Vera-Hernández AM (1999) Duplicate coverage and demand for health care. The case of Catalonia. Health Econ 8:579–598CrossRefPubMedGoogle Scholar
  27. 27.
    Wagstaff A (1986) The demand for health. Some new empirical evidence. J Health Econ 5:195–233CrossRefPubMedGoogle Scholar
  28. 28.
    Winkelmann R (1998) Count data models with selectivity. Economet Rev 17:339–359Google Scholar
  29. 29.
    Winkelmann R (2001) Health care reform and the number of doctor visits—an econometric analysis. IZA discussion paper 317Google Scholar
  30. 30.
    Zweifel P (1981) Demande medical induite par l’offer: Chimere ou realite? Consomation 4:39–62Google Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Sergi Jiménez-Martín
    • 1
  • José M. Labeaga
    • 2
  • Maite Martínez-Granado
    • 3
  1. 1.Department of EconomicsUniversidad Pompeu FabraBarcelonaSpain
  2. 2.UNEDMadridSpain
  3. 3.Universidad Carlos III de MadridMadridSpain

Personalised recommendations