Choice of a regular physician and health care utilization: principal-agent issues for American veterans

Abstract

Using US Veterans Health Administration (VA) data, we examined factors that affected patients choice of regular physicians and how the location of regular physicians influenced patients health care use. Appropriate estimation methods were applied to control for the endogeneity of patients choice of regular physicians. Our study showed that VA enrollees with regular VA physicians were more likely to use VA for inpatient care while those with regular nonVA physicians were more likely to use VA for special care such as pharmacy or mental health/substance abuse treatment, both of which can have very limited coverage in nonVA settings.

Acknowledgements

The author gratefully acknowledges Ann Hendricks, John Gardner, Tom McGuire, Lewis Kazis and Kevin Lang for helpful comments and suggestions. I am grateful to Fenghua Wang and Duozhe Li for excellent programming assistance. The responsibility for all errors and opinions is mine. This work was supported by grant #ECI 20-032-2, the Health Services Research and Development Service and Office of Quality and Performance the Veterans Health Administration.