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Association between physician density and health care consumption: A systematic review of the evidence

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  • Léonard, Christian
  • Stordeur, Sabine
  • Roberfroid, Dominique
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    Abstract

    Background Supplier-induced demand (SID) for health care could be a crucial factor of rising health expenditures. However, there is thus far no consensus on the topic.Objective To assess how physician density (physician-to-population ratio) and health care consumption correlate.Methods A systematic review of studies retrieved through electronic databases: Medline, Econlit, PsychINFO and Embase. Search, inclusion and quality appraisal were based on standard procedures and applied independently by two researchers.Results Twenty-five studies, generally of moderate quality, were included. Despite a substantial heterogeneity in study design and data modelling, a significant association between physician density and health care consumption was consistently observed. However, estimates varied according to a number of method parameters such as the definition of the dependent variable (physician volume or care intensity), the geographical entity or the medical specialty under consideration, and the adjustment for confounding factors.Conclusions The exact importance of SID and the underlying motivations remain poorly understood. We discuss technical issues for better SID assessment. In the absence of more accurate information, limiting physician supply as a measure of cost containment should also be considered cautiously.

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    Bibliographic Info

    Article provided by Elsevier in its journal Health Policy.

    Volume (Year): 91 (2009)
    Issue (Month): 2 (July)
    Pages: 121-134

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    Handle: RePEc:eee:hepoli:v:91:y:2009:i:2:p:121-134

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    Web page: http://www.elsevier.com/locate/healthpol

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    Keywords: Supplier-induced demand Cost containment Physician density Healthcare consumption Patient and physician responsibility;

    References

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    Cited by:
    1. Shmueli, Amir & Nissan-Engelcin, Esti, 2013. "Local availability of physicians' services as a tool for implicit risk selection," Social Science & Medicine, Elsevier, vol. 84(C), pages 53-60.
    2. Blankart, Carl Rudolf, 2012. "Does healthcare infrastructure have an impact on delay in diagnosis and survival?," Health Policy, Elsevier, vol. 105(2), pages 128-137.
    3. Roll, Kathrin, 2012. "The influence of regional health care structures on delay in diagnosis of rare diseases: The case of Marfan Syndrome," Health Policy, Elsevier, vol. 105(2), pages 119-127.
    4. Anand, Sudhir & Bärnighausen, Till, 2012. "Health workers at the core of the health system: Framework and research issues," Health Policy, Elsevier, vol. 105(2), pages 185-191.
    5. Mazumdar, Soumya & Winter, Alix & Liu, Ka-Yuet & Bearman, Peter, 2013. "Spatial clusters of autism births and diagnoses point to contextual drivers of increased prevalence," Social Science & Medicine, Elsevier, vol. 95(C), pages 87-96.
    6. Lin, Yen-Ju & Tian, Wei-Hua & Chen, Chun-Chih, 2011. "Urbanization and the utilization of outpatient services under National Health Insurance in Taiwan," Health Policy, Elsevier, vol. 103(2), pages 236-243.
    7. Rudy Douven & Remco Mocking & Ilaria Mosca, 2012. "The Effect of Physician Fees and Density Differences on Regional Variation in Hospital Treatments," CPB Discussion Paper 208, CPB Netherlands Bureau for Economic Policy Analysis.

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