||The purpose of this thesis is to investigate whether patients with liver cancer could have better treatment outcome if they seek care in areas far from their residence. The data resource is 1998-2009 liver cancer patients extracted from the 2000 Longitudinal Health Insurance Database (LHID2000) which is distributed by the f National Health Research Institutes. Patients are recognized as crossing area to seek care if the distances between patients’ residences and hospitals are over 20 kilometers and their areas are different. However, there is no information of patient’s residence available in the National Health Insurance Database. As such, we adopt following procedures to identify patient’s crossing-area-seeking-care behavior: First, we identify a patient’s residence as the area where the patient had several records of seeking care with minor diseases one year before cancer diagnosed. Second, if the patient did not have records of care for minor diseases, we use the area where the patient enroll in NHI as the patient’s residence. The decision of cross-area-seeking-care would be endogenous to the treatment outcome because the unobserved factors such as severity may affect patient’s treatment outcome and also motivate the patient to seek care in areas with more abundant medical resources. Hence, two stage least square (2SLS) estimation was adopted to take into account the endogeneity problem. |
Our empirical results show that mortality rate of the patients who used medical care by crossing region is significantly lower than those who didn’t. We can make a conclusion that patients who live in the area with poor medical resources are able to obtain better medical outcomes by crossing areas to seek better medical diagnosis and treatment. This raises a policy implication of equalizing medical resources across areas to secure the quality of care for each patient no matter where he/she lives.
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