Surveys in Mathematics and its Applications

ISSN 1842-6298 (electronic), 1843 - 7265 (print)
Volume 2 (2007), 91 - 112


Stefano Mainardi

Abstract. Adequate coverage and efficiency of public health services are high priorities for sustainable growth and development. In many countries, public healthcare continues to fall short of demand, and remains unevenly distributed among the population. As in other areas of project appraisal, studies on social equity and access to public utilities are fraught with theoretical and empirical questions. Based on the concepts of marginal disutility with respect to distance, safety thresholds and `equally distributed equivalent' distance, the paper first reassesses utility theory assumptions supporting the rationale for functional re-specifications. Partly drawing on these theoretical refinements, the analysis formulates a stochastic cost frontier hurdle model with an endogenously determined hospital distance threshold. For illustrative purposes, this model is applied to pooled biennial communal data for Chile. Healthcare accessibility in terms of travel cost/time is proxied by distances of administrative centres from the nearest emergency hospitals over the period 2000-2003.

2000 Mathematics Subject Classification: 91B16, 91B70, 91B99.
Keywords: access to healthcare, marginal disutility, stochastic cost frontier, distance threshold.

Full text

Acknowledgment. This research was undertaken while the author was at UCN (Universidad Catolica del Norte), Antofagasta, Chile. The author is grateful to an anonymous referee for comments on an earlier version.


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Stefano Mainardi
Department of Informatics and Econometrics,
UKSW- Card. S. Wyszy\'nski University,
ul. Dewajtis 5, 01815, Warsaw,