Comparability of Health Care Responsiveness in Europe

1
Comparability of Health CareResponsiveness in
Europe

• Nicolas Sirven (IRDES)
• Brigitte Santos-Eggimann (IUMSP)
• Jacques Spagnoli (IUMSP)

2
Rationale

• Health care responsiveness
• the extent to which the process of care
  delivery matches patients expectations (Murray
  et al., 2004)
• Evaluating health care systems by asking people
  about their own experience (subjective statement)
• ? cultural differences make comparisons
  difficult
• Vignette method to correct for response style
  bias is currently applied in WHO survey (King et
  al., 2004)
• COMPARE What can we learn from 50 in Europe?

3
Example Time to wait

• Own experience
• In many countries, it takes time before people
  can see a specialist and there are waiting lists
  for certain procedures.
• Overall, in your situation, how would you rate
  the amount of time you have to wait for medical
  treatment?
• Very short Short Reasonable Long
  Very long
• Vignette (common situation)
• Jim has a stomach problem, which causes a lot of
  pain and requires surgery. He is immediately
  admitted to hospital and constantly monitored and
  his pain is relieved with strong pain-killers,
  but because the problem is not life threatening,
  he has to wait four days before surgery takes
  place.
• Overall, how would you rate the amount of time
  Jim has to wait for medical treatment?
• Very short Short Reasonable Long
  Very long

x
x
4
Data Method

• SHARE Wave 2, cross-sectional analysis (v.1.0)
• Health Care Responsiveness (scaled 1-5)
• Time to wait for medical treatment
• Conditions of the health facilities
• Communication with physicians
• Vignette 1 (Ngt6,000 individuals)
• CHOPIT estimates for each domain (Stata gllamm)
• Covariates
• Gender, Age, Education
• Health (IADL, Euro-D, Smoke Drink)
• Country dummies
• Thresholds modelled with the same covariates

5
Cross-country comparisons

• Counterfactual simulations for the whole SHARE w2
  sample
• (1) self-assessment as it would be observed for
  the whole population, taking into account
  socio-economic characteristics
• (2) same self assessment if everyone would
  understand the question like people in a
  benchmark country (e.g. Germany)
• (1) (2) DIF or reporting style bias
• Exploring comparable international differences in
  health care responsiveness with
• Satisfaction Balance statistic ( good, very
  good) ( bad, very bad)
• Public expenditures on health per capita (USD at
  2000 PPP rates)
• ? detailed results on www.irdes.fr, working
  paper DT15

6
Satisfaction with Time to wait for treatment
7
Satisfaction with Conditions of the health
facilities
8
Satisfaction with Communication with doctors
9
Conclusion

• Our results show international differences in
  response style (DIF)
• Correction for response style bias suggest that
• Time to wait for medical treatment ?
  overestimated
• Conditions of the health facilities ?
  underestimated
• Communication with physicians ? underestimated
• Comparable differences in cross-country health
  care responsiveness indicates that satisfaction
  is associated with public expenditures
• This correlation is better when DIF is corrected
  (? R², ? slope)
• Each euro spent increases satisfaction in
  conditions of the health facilities and
  communication more than we thought
• Vignettes help understand better health
  differences in Europe

10
Thank you

• Correspondence to Nicolas Sirven
• sirven_at_irdes.fr