Health econometric essays on physician learning and beneficial health insurance
13 December 2017
University of Antwerp, Stadscampus - Hof van Liere - F. de Tassiszaal, Prinsstraat 13 - 2000 Antwerp (route: UAntwerpen, Stadscampus
Raf Van Gestel
Prof Diana De Graeve
PhD defence Raf Van Gestel - Faculty of Applied Economics
Physician learning is multifaceted and can be approached from different angles. In this field, the literature predominantly focuses on volume-outcome thresholds, which limit medical procedures to be offered only in high volume hospitals. However, other processes that may determine physician performance are (non-exclusively); learning-by-doing, human capital depreciation, economies of scale, learning from failure, subgroup learning, etc. For Transcatheter Aorta Valve Implantation, this doctoral thesis provides evidence for all previously mentioned processes except for economies of scale. As such, this thesis stresses the importance of looking at different channels of physician learning to ultimately improve physician performance and healthcare quality.
In a second stream of research, this thesis discusses the take-up and impact of a beneficial health insurance scheme in Belgium, namely the Increased Reimbursement (IR – Verhoogde Tegemoetkoming). With a large-scale scale experiment we show that an information campaign, consisting of a letter and a flyer, causes a fourfold increase in the take-up of IR. Although there are significant regional variation in the response to information, we arguably find that the most vulnerable part of the population is on average reached with the campaign. Following up on this experiment, there is only modest evidence of a consumptive response to the IR. This means that, with beneficial insurance, when individuals and households pay less for healthcare, consumption of healthcare services hardly increases. Looking at different types of healthcare, we only find evidence of an increased utilization of GP services. However, spending for individual households may decrease.