Research Brief

Self-rated Health and Endogenous Selection into Primary Care

Bilgel, Firat and Can Karahasan (2019). Social Science & Medicine.


Self-rated health (SRH) has been viewed as a reliable measure of population health and as a powerful predictor of mortality, morbidity, and healthcare utilization. This paper uses individual-level data to assess the causal effect of primary care utilization on SRH in Turkey, where relatively little research has focused on health care outcomes. Because unobservable factors may simultaneously affect both healthcare utilization and SRH, the analysis uses a statistical approach to account for such joint impacts.

This study finds that after important factors affecting health outcomes such as income, household demographics, and access to healthcare are taken into account, the utilization of preventative care significantly improves SRH levels.  

Critically, the study also finds that residents in urban areas, singles, undereducated, and the poor are more likely to report low SRH but are less likely to utilize health care. Further, significant location-based inequalities exist in the utilization of preventative care among patients with chronic conditions, indicating substantial differences in access to preventive and other forms of health care. Instead of building new hospitals that run with 60–70 percent occupancy rates, the government should therefore consider direct financial resources to family health centers in urban areas.