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50. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds)
12. Jahrestagung der Deutschen Arbeitsgemeinschaft für Epidemiologie (dae)

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie
Deutsche Arbeitsgemeinschaft für Epidemiologie

12. bis 15.09.2005, Freiburg im Breisgau

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Assessing access to medical care through an epidemiological extension of econometric hurdle models

Meeting Abstract

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  • Karl J. Krobot - University of North Carolina at Chapel Hill, NC, USA
  • Jay S. Kaufman - University of North Carolina at Chapel Hill, NC, USA
  • Dale B. Christensen - University of North Carolina at Chapel Hill, NC, USA
  • John S. Preisser - University of North Carolina at Chapel Hill, NC, USA
  • William C. Miller - University of North Carolina at Chapel Hill, NC, USA
  • Michel A. Ibrahim - University of North Carolina at Chapel Hill, NC, USA

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie. Deutsche Arbeitsgemeinschaft für Epidemiologie. 50. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 12. Jahrestagung der Deutschen Arbeitsgemeinschaft für Epidemiologie. Freiburg im Breisgau, 12.-15.09.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc05gmds111

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/gmds2005/05gmds013.shtml

Published: September 8, 2005

© 2005 Krobot et al.
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Outline

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Introduction and objectives

Only on a limited scale has healthcare epidemiology taken possession of questions involving different decision-makers and processes. We therefore extended the classical econometric hurdle model toward a framework designed to better characterize barriers to receipt of services under different funding policies.

Methods

We used the example of the first selective vascular 5HT 1B/1D receptor agonist sumatriptan in a cohort of 7358 statutorily (SHI) and 457 fully privately health insured (PHI) patients with migraine headaches at 377 primary-care practices (MediPlus, IMS Health) in the second (1994) to fourth (1996) year of the HealthCare Structural Reform Act in Germany. Single-failure proportional hazards regression among patients with migraine and zero-truncated negative binomial models with precisely defined offsets among sumatriptan users were employed.

Results

For SHI compared to PHI migraine patients, receiving sumatriptan at all constituted a hurdle (2.4-fold lower hazard, 95% confidence interval 1.8–3.2), whereas among sumatriptan users, frequency and intensity of use differed only minimally in SHI and PHI.

Conclusions

Single-stage modeling of determinants of the microcosm of the physician-patient relationship may be highly misleading. Epidemiologically oriented, three-dimensional, person-time-linked frameworks extend econometric hurdle models and can help quantifying barriers to receipt of services under different funding policies.