Dynamic Stochastic Model of Medical Care Use and Work Absence. Abstract andExecutive Summary of Doctorate Dissertation

摘要

This research focuses on one aspect of health care demand: the medical careconsumption and absenteeism behavior of employed individuals with acute illness. The theoretical framework models the decisions to visit a doctor and/or to miss work during an episode of acute illness as the sequential choices of individuals solving a discrete choice finite horizon stochastic dynamic programming problem. Using data from the 1987 National Medical Expenditure Survey (NMES), I estimate the parameters of an individual's optimization problem. Structural estimation, as opposed to conventional reducded form estimation methods that are prevalent in the health care literature, allows for the introduction and evaluation of the impact of new public policy initiatives relating to health care. The estimates allow for predictions of the change in physician services use and illness-related absenteeism that would arise with improvements in access to health care through more complete health insurance and sick leave coverage and with changes in consumer cost sharing.