The effect of private insurance access on the choice of GP/specialist and public/private provider in Spain

TLDR

Studies show that utilization of physician services varies across population subgroups, raising equity concerns about specialist versus general practitioner care. The study aims to explain how insurance type influences the choice between specialists and GPs and between private and public providers using 1997 Spanish National Health Survey data. A two‑stage probit model shows that insurance access is the main determinant of both sector choice and physician type, producing distinct GP and specialist visit patterns. People with only public insurance visit GPs 2.8 times more than specialists, those with duplicate coverage have a 1.4 GP‑to‑specialist ratio, while those with only private insurance visit specialists more often; age, sex, health status, and public supply characteristics also influence these choices.

Abstract

This paper sheds light into the investigation of differential patterns of utilisation of physician services by populations subgroups that is emerging in a number of studies. Using Spanish data from the National Health Survey of 1997 we try to explain the distinct role of the type of insurance on the choice between specialists and GPs and its intertwining with the choice between private and public providers. We estimate a two-stages probit to conclude that differences in insurance access is the main determinant of both, the choice of sector and the kind of physician contacted, giving rise to very different patterns of consumption of GP and specialist visits. People with only public insurance go 2.8 times to the GP per one time that they visit a specialist; individuals with duplicate coverage have a ratio of GP/specialist visits equal to 1.4 (the combination being public GP and private specialist) and people with only private insurance access actually have an 'inverted' pattern of visits: they contact specialists more often than GPs. Age, sex and health and public supply characteristics also have a distinct and interesting impact on these choices. Finally, equity concerns based on the implied assumption that specialists care is superior to general practitioner care are discussed.