Self-rated health and endogenous selection into primary care. (January 2018)

• Record Type: Journal Article
• Authors: Bilgel, Fırat; Karahasan, Burhan Can
• Is Part Of: Social science & medicine. Volume 197(2018)
• Page Start: 168
• Page End: 182
• Publication Date: 2018-01
• Subjects: Recursive bivariate models -- Ordinal outcomes -- Treatment effects -- Preventive care -- Turkey; I12 -- I14 -- C31; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2017.11.057
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: This study assesses the causal effects of primary care utilization on subjective health status in Turkey using individual-level data from the 2012 Health Research Survey. Employing recursive bivariate ordered models that take into account the possibility that selection into healthcare might be correlated with the respondent's self-reported health status, we find that selection into primary care is endogenously determined and that the utilization of primary care significantly improves self-rated health after controlling for sociodemographics, socioeconomic status, health behaviors and risk factors, and access to healthcare. We show that the causal association between healthcare utilization and health status is robust to the use of objective measures of health and specific types of care, suggesting that the use of a single-item question on self-rated health and binary measures of preventive care utilization is valid. Highlights: Healthcare utilization and health status are simultaneously determined by unobservable factors. Preventive care utilization exerts a causal impact on health status after controlling for confounders. The causal association is robust to objective health measures and specific types of healthcare. Self-rated health and healthcare utilization are valid measures in the Turkish case. Knowledge of the assignment of a family physician is a valid instrument for healthcare utilization.