UBC Theses and Dissertations
Private health service, public waiting time and patient welfare : theoretical modeling and empirical evidence Qian, Qu
Motivated by health reform debates and policy changes in Canada and other OECD countries, we study how the private and public health care impact on the public health waiting time and more generally the welfare of patients. This thesis encompasses theoretical and empirical research. In Chapter 2, we develop a theoretical model and then empirically test the association between allowing private care financing and public waiting time using joint replacement surgery data of nine Canadian provinces. Two policies that induce private care financing are tested. The empirical results suggest that both policies are associated with shorter public waiting times. This work contributes to the existing literature by providing an empirical analysis of the relationship between private care financing and public health waiting time under a unique institutional setting. In Chapter 3, we investigate the effect of physician dual practice on public waiting time and patient welfare. Motivated by Manitoba’s cataract surgery evidence, our study shows that the public waiting time difference existing between dual-practice physicians and public-only physicians can be explained by service quality differentiation. Patients with lower time costs would have a longer waiting time if physician dual practice were allowed. But some of these patients could be better off by receiving a service of higher quality induced by allowing physician dual practice. This work contributes to the limited literature of physician dual practice. In Chapter 4, we study the use of tax or subsidy on private care to improve income redistribution given that the public health system is financed by a head tax. When the utilization of the public health system is low, the health planner should subsidize private care to induce patients with higher time costs to the private sector. The production cost of public care would then be reduced and so would be the head tax that everyone pays for. We show that the optimal tax/subsidy decision improves income redistribution when the utilization of public health system is either high or low. This work contributes to the literature of public provision of private goods on income redistribution.
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