“Doctor my eyes”: A natural experiment on the demand for eye care services

H Dickey, D Ikenwilo, P Norwood, V Watson, A Zangelidis* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)
10 Downloads (Pure)


Preventive health care is promoted by many organisations from the World Health Organisation (WHO) to regional and national governments. The degree of cost-sharing between individuals and the health care service affects preventive service use. For instance, out-of-pocket fees that are paid by individuals for curative services reduce preventive care demand. We examine the impact of subsidised preventive care on demand. We motivate our analysis with a theoretical model of inter-temporal substitution in which individuals decide whether to have a health examination in period one and consequently whether to be treated if required in period two. We derive four testable hypotheses. We test these using the subsidised eye care policy introduced in Scotland in 2006. This provides a natural experiment that allows us to identify the effect of the policy on the demand for eye examinations. We also explore socio-economic differences in the response to the policy. The analysis is based on a sample from the British Household Panel Survey of 52,613 observations of people, aged between 16 and 59 years, living in England and Scotland for the period 2001–2008. Using the difference-in-difference methodology, we find that on average the policy did not affect demand for eye examinations. We find that demand for eye examinations only increased among high income households, and consequently, inequalities in eye-care services demand have widened in Scotland since the introduction of the policy.
Original languageEnglish
Pages (from-to)117-127
Number of pages11
JournalSocial Science & Medicine
Early online date28 Dec 2015
Publication statusPublished - Feb 2016

Bibliographical note

This paper is dedicated to our friend Divine Ikenwilo, who passed away on the 27th November 2015. Divine was a gifted researcher who was taken from us too early and will be sorely missed by everyone in the team. Our thoughts are with his family. This research was funded by a research grant (CGZ/2/533) from the Chief Scientist Office of the Scottish Government. The Health Economics Research Unit is funded by the Scottish Government Health and Social Care Directorate. The usual disclaimer applies.


  • UK
  • Scotland
  • preventive care
  • subsidised care
  • eye examinations
  • natural experiment


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