Artikel
Assessing access to medical care through an epidemiological extension of econometric hurdle models
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Autoren
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Karl J. Krobot
- University of North Carolina at Chapel Hill, NC, USA
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Jay S. Kaufman
- University of North Carolina at Chapel Hill, NC, USA
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Dale B. Christensen
- University of North Carolina at Chapel Hill, NC, USA
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John S. Preisser
- University of North Carolina at Chapel Hill, NC, USA
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William C. Miller
- University of North Carolina at Chapel Hill, NC, USA
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Michel A. Ibrahim
- University of North Carolina at Chapel Hill, NC, USA
| Veröffentlicht: | 8. September 2005 |
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Gliederung
Text
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.
