Testing and Correcting for Non-Random Selection Bias due to Censoring: An Application to Medical Costs

Censoring is a common problem with medical cost data. Methods from traditional survival analysis are not directly applicable to estimate medical costs since patients accumulate costs with different rate functions over time, leading to negatively biased estimates. Heckman's two-step estimator results in large variances when identical explanatory variables that influence selection are included in the structural equation, i.e. when there are no exclusion restrictions. This paper provides a systematic treatment of the correction for nonrandom sample selection bias of medical cost data where the selection rule is described by a censored regression model. The proposed method first uses the duration of time a patient is tracked for the selection, rather than a binary variable, namely whether or not the duration is censored. Second, using Tobit residuals instead of the inverse Mills ratio in the structural equation allows us to decrease large variances introduced by the Heckman model when there are no exclusion restrictions. We show that the resulting estimators are consistent and asymptotically normal. Simulation studies confirmed our results. Moreover, we derive a simple test to determine possible sample selection bias due to censoring. Data from a study on the medical cost of breast, prostate, colon, and lung cancer is used as an application of the method.