VOLUME 48 | NUMBER 5 | OCTOBER 2013
Beta-Binomial Regression and Bimodal Utilization
Keywords: Beta-binomial;bimodal;veterans;primary care;Medicare;utilization
Objective: To illustrate how the analysis of bimodal U-shaped distributed utilization can be modeled with beta-binomial regression, which is rarely used in health services research.
Data Sources/Study Setting: Veterans Affairs (VA) administrative data and Medicare claims in 2001–2004 for 11,123 Medicare-eligible VA primary care users in 2000.
Study Design: We compared means and distributions of VA reliance (the proportion of all VA/Medicare primary care visits occurring in VA) predicted from beta-binomial, binomial, and ordinary least-squares (OLS) models.
Principal Findings: Beta-binomial model fits the bimodal distribution of VA reliance better than binomial and OLS models due to the nondependence on normality and the greater flexibility in shape parameters.
Conclusions: Increased awareness of beta-binomial regression may help analysts apply appropriate methods to outcomes with bimodal or U-shaped distributions.
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