Patient payments and the empirical analysis of consumer demand for hospital services: An application for Bulgaria

The implementation or amendment of patient charges in a country could benefit from preliminary analyses of their potential effects on health care demand. This paper focuses on hospital care. The paper aims to identify strategies for the empirical analysis of the demand for hospital services that are useful for the assessment of patient charges in the hospital sector, and to compare these strategies using empirical data for Bulgaria. The data were collected in 2010 in a representative survey among consumers. We apply both revealed- and stated-preference approaches. Within the framework of revealed preferences, we use data on various types of patient payments (total payments, formal payments and informal payments) as dependent variables to define three empirical models. Within the framework of stated preferences, we use data on stated willingness to pay for a hospitalization for different sub-samples (current users, users and all respondents), which also results in three empirical models. We observe some similarities and differences between the models based on stated-preference data and those based on revealed-preference data. Although our findings need to be studied further to establish how rigorous they are, they can be useful for setting up new studies on the convergent validity of the two approaches.