Abstract

This thesis is an empirical exploration into a range of issues related to the economics of the utilization of physician services. Physicians play an important role in a health care system as physicians are a patient's primary point of contact with the health care system and physicians are predominantly responsible for directing how patients use other health care resources. In particular, physicians are at the center of Canada's universal public insurance system with first dollar coverage for medically necessary physician and hospital services.

The thesis comprises three separate essays. The first essay has a methodological focus on statistically modeling and predicting the use of general practitioners (GPs) when use is measured as the number of GP visits. The essay compared a state-of-the-art parametric latent class negative binomial model to a nonparametric kernel conditional density estimator, and evaluated how well each was able to fit the observed data and predict physician use. The second and third essays look at more substantive policy questions.

The second essay investigates how the supply of GPs and specialists affects the mix of physician services received by individuals. A persistent concern in many health care systems is how variations in the supply of physicians will impact the use of physician services. The results suggest concerns about concerns of patient access and receipt of care in the presence of a shortage of specialists may be mitigated, all else equal, if patients are able to substitute GP services for specialist services.

The third essay examines income-related inequity in the use of physician services by asthmatics and diabetics, relative to the general population, and the contributions of different factors to income-related inequality using the concentration index approach.