Nóra Kungl - Geographic and Socioeconomic Variation in Healthcare: Evidence from Migration

  • Presenting author: Nóra Kungl (Centre for Economic and Regional Studies and Corvinus University of Budapest)

  • Authors: Péter Elek, Anita Győrfi, Nóra Kungl, Dániel Prinz

  • Session: C01B - Health [2] - Wednesday 9:00-10:30 - Marietta-Blau Hall

  • Slides: PDF


We study variation in healthcare utilization across geographies and socioeconomic groups in the context of Hungary, a healthcare system with universal coverage. We exploit migration across geographic regions to decompose utilization into place- and individual-specific components.


We use individual-level administrative panel data on healthcare use and income for years 2009-2017. First, we estimate models with patient and place fixed effects in difference-in-differences and event study settings. Second, we investigate the association of the estimated place effects with place-level healthcare supply, geographic and socioeconomic variables.


First, the role of place-specific supply factors is heterogeneous across types of care and across socioeconomic groups. Overall, place-specific factors account for 68% of the variation in outpatient spending and 35% of the variation in drug spending, but almost none of the variation in inpatient spending. There is also important heterogeneity by socioeconomic status in the role of place in outpatient spending. In our working age sample, the estimated place share is 79% for non-workers and 63% for those in the bottom quartile of the wage distribution, which is significantly higher than the place share of 35-38% for workers above the median wage. Among the elderly, place-specific factors explain 89% of the variation for low-income pensioners but only 67% for high-income pensioners. Second, outpatient place effects are positively associated with local outpatient care capacity, and the gradient of this relationship is steeper at lower levels of capacity. The estimated relationship between capacity and place effects is consistent with previous quasi-experimental evidence coming from building new outpatient capacities in rural areas of Hungary. Outpatient capacity influences the utilization of lower-income individuals more strongly than that of higher-income ones.


These results suggest that access to healthcare varies even in a context with universal coverage. When resources are scarce, low-income groups are hurt disproportionately even in such a system. Increasing the capacity of the healthcare system might enable better access to care for low-income individuals and enable providers to spend more time and resources on all patients. Future work should investigate the causal mechanisms behind the role of healthcare capacity in socioeconomic disparities when access is nominally equal and universal.


Working paper is available at https://kti.krtk.hu/wp-content/uploads/2023/06/KRTKKTIWP202318.pdf