City Research Online

Estimating the Impact of Medical Care Usage on Work Absenteeism by a Trivariate Probit Model with Two Binary Endogenous Explanatory Variables

Filippou, P., Marra, G., Radice, R. ORCID: 0000-0002-6316-3961 & Zimmer, D. (2022). Estimating the Impact of Medical Care Usage on Work Absenteeism by a Trivariate Probit Model with Two Binary Endogenous Explanatory Variables. AStA: Advances in Statistical Analysis: A Journal of the German Statistical Society, 107(4), pp. 713-731. doi: 10.1007/s10182-022-00464-6


The aim of this paper is to estimate the effects of seeking medical care on missing work. Specifically, our case study explores the question: Does visiting a medical provider cause an employee to miss work? To address this, we employ a model that can consistently estimate the impacts of two endogenous binary regressors. The model is based on three equations connected via a multivariate Gaussian distribution, which makes it possible to model the correlations among the equations, hence accounting for unobserved heterogeneity. Parameter estimation is reliably carried out via a trust region algorithm with analytical derivative information. We find that, observationally, having a curative visit associates with a nearly 80 percent increase in the probability of missing work, while having a preventive visit correlates with a smaller 13 percent increase in the likelihood of missing work. However, after addressing potential endogeneity, neither type of visit appears to significantly relate to missing work. That finding also applies to visits that occur during the previous year. Therefore, we conclude that the observed links between medical usage and absenteeism derive from unobserved heterogeneity, rather than direct causal channels. The modeling framework is available through the R package GJRM.

Publication Type: Article
Additional Information: This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at:
Publisher Keywords: endogeneity, medical care, multivariate Gaussian, simultaneous equation model, work absenteeism
Subjects: H Social Sciences > HB Economic Theory
R Medicine > RA Public aspects of medicine
Departments: Bayes Business School > Actuarial Science & Insurance
SWORD Depositor:
[thumbnail of draft_revised.pdf]
Text - Accepted Version
Download (193kB) | Preview


Add to AnyAdd to TwitterAdd to FacebookAdd to LinkedinAdd to PinterestAdd to Email


Downloads per month over past year

View more statistics

Actions (login required)

Admin Login Admin Login