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GP reimbursement and visiting behaviour in Ireland

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Author Info
David Madden (University College Dublin, Dublin, Ireland)
Anne Nolan (Economic and Social Research Institute, Dublin, Ireland)
Brian Nolan (Economic and Social Research Institute, Dublin, Ireland)

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Abstract

In Ireland, approximately 30% of the population receive free GP services ('medical card patients') while the remainder ('private patients') must pay for each visit. In 1989, the manner in which GPs were reimbursed by the State for their medical card patients was changed from fee-for-service to capitation while private patients continued to pay on a fee-for-service basis. Concerns about supplier-induced demand were in part responsible for this policy change. The purpose of this paper is to examine the extent to which the utilisation of GP services is influenced by the reimbursement system facing GPs, by comparing visiting rates for the two groups before and after this change. Using a difference-in-differences approach on pooled micro-data from 1987, 1995 and 2000, we find that medical card eligibility has a consistently positive and significant effect on the utilisation of GP services. However, the differential in visiting rates between medical card patients and others did not narrow between 1987 and 1995 or 2000, as might have been anticipated if supplier-induced demand played a major role prior to the change in reimbursement system. Copyright © 2005 John Wiley & Sons, Ltd.

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File URL: http://hdl.handle.net/10.1002/hec.995
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Publisher Info
Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

Volume (Year): 14 (2005)
Issue (Month): 10 ()
Pages: 1047-1060
Download reference. The following formats are available: HTML (with abstract), plain text (with abstract), BibTeX, RIS (EndNote, RefMan, ProCite), ReDIF
Handle: RePEc:wly:hlthec:v:14:y:2005:i:10:p:1047-1060

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Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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References listed on IDEAS
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
  1. Nolan, Brian, 1991. "The Utilisation and Financing of Health Services in Ireland," Research Series, Economic and Social Research Institute (ESRI), number GRS155, November.
  2. Chiappori, Pierre-Andre & Durand, Franck & Geoffard, Pierre-Yves, 1998. "Moral hazard and the demand for physician services: First lessons from a French natural experiment," European Economic Review, Elsevier, vol. 42(3-5), pages 499-511, May. [Downloadable!] (restricted)
    Other versions:
  3. Thomas C. Buchmueller & Agnes Couffinhal & Michel Grignon & Marc Perronin, 2002. "Access to Physician Services: Does Supplemental Insurance Matter? Evidence from France," NBER Working Papers 9238, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
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  4. Carine Van De Voorde & Eddy Van Doorslaer & Erik Schokkaert, 2001. "Effects of cost sharing on physician utilization under favourable conditions for supplier-induced demand," Health Economics, John Wiley & Sons, Ltd., vol. 10(5), pages 457-471. [Downloadable!]
  5. J Durkan; & C Harmon; & J Hughes, 1996. "Health Services Utilisation in the UK. An Empirical Analysis Using Microdata," Economics, Finance and Accounting Department Working Paper Series n650796, Department of Economics, Finance and Accounting, National University of Ireland - Maynooth.
  6. Callan, Tim & Nolan, Brian & Whelan, Brendan J. & Hannan, Damian F. & Creighton, S., 1989. "Poverty, Income and Welfare in Ireland," Research Series, Economic and Social Research Institute (ESRI), number GRS146, November.
  7. Russell, Helen & Layte, Richard & Maitre, Bertrand & O'Connell, Philip J. & Whelan, Christopher T., 2004. "Work-Poor Households: The Welfare Implications of Changing Household Employment Patterns," Research Series, Economic and Social Research Institute (ESRI), number PRS52, November.
  8. Croxson, B. & Propper, C. & Perkins, A., 2001. "Do doctors respond to financial incentives? UK family doctors and the GP fundholder scheme," Journal of Public Economics, Elsevier, vol. 79(2), pages 375-398, February. [Downloadable!] (restricted)
  9. Sergi Jiménez-Martín & José M. Labeaga & Maite Martínez-Granado, 2002. "Latent class versus two-part models in the demand for physician services across the European Union," Health Economics, John Wiley & Sons, Ltd., vol. 11(4), pages 301-321. [Downloadable!]
  10. Richard Blundell & Monica Costa Dias, 2000. "Evaluation methods for non-experimental data," Fiscal Studies, Institute for Fiscal Studies, vol. 21(4), pages 427-468, January. [Downloadable!]
  11. Grytten, Jostein & Sorensen, Rune, 2001. "Type of contract and supplier-induced demand for primary physicians in Norway," Journal of Health Economics, Elsevier, vol. 20(3), pages 379-393, May. [Downloadable!] (restricted)
  12. Ángel Marcos Vera-Hernández, 1999. "Duplicate coverage and demand for health care. The case of Catalonia," Health Economics, John Wiley & Sons, Ltd., vol. 8(7), pages 579-598.
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  14. Hurd, Michael D. & McGarry, Kathleen, 1997. "Medical insurance and the use of health care services by the elderly," Journal of Health Economics, Elsevier, vol. 16(2), pages 129-154, April. [Downloadable!] (restricted)
  15. Cockx, Bart & Brasseur, Carine, 2003. "The demand for physician services: Evidence from a natural experiment," Journal of Health Economics, Elsevier, vol. 22(6), pages 881-913, November. [Downloadable!] (restricted)
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  16. Cromwell, Jerry & Mitchell, Janet B., 1986. "Physician-induced demand for surgery," Journal of Health Economics, Elsevier, vol. 5(4), pages 293-313, December. [Downloadable!] (restricted)
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  18. Gerdtham, Ulf-G. & Trivedi, Pravin K., 2000. "Equity in Swedish Health Care Reconsidered: New Results based on the Finite Mixture Model," Working Paper Series in Economics and Finance 365, Stockholm School of Economics. [Downloadable!]
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  19. Grytten, Jostein & Carlsen, Fredrik & Sorensen, Rune, 1995. "Supplier inducement in a public health care system," Journal of Health Economics, Elsevier, vol. 14(2), pages 207-229, June. [Downloadable!] (restricted)
  20. Mark Dusheiko & Hugh Gravelle & Rowena Jacobs & Peter Smith, 2003. "The Effects of Budgets on Doctors Behaviour: Evidence from a Natural Experiment," The Centre for Market and Public Organisation 03/064, Department of Economics, University of Bristol, UK. [Downloadable!]
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Full references

Cited by:
(explanations, Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.)

  1. Nolan, Anne & Nolan, Brian, 2004. "Ireland's Health Care System: Some Issues and Challenges," Papers HRBWP14, Economic and Social Research Institute (ESRI). [Downloadable!]
  2. Lieke H. H. M. Boonen & Frederik T. Schut & Xander Koolman, 2008. "Consumer channeling by health insurers: natural experiments with preferred providers in the Dutch pharmacy market," Health Economics, John Wiley & Sons, Ltd., vol. 17(3), pages 299-316. [Downloadable!]
  3. Miriam M. Wiley, 2005. "The Irish health system: developments in strategy, structure, funding and delivery since 1980," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages S169-S186. [Downloadable!]
  4. Jacqueline O'Reilly & Miriam M. Wiley, 2007. "The Public/Private Mix in Irish Acute Public Hospitals: Trends and Implications," Papers WP218, Economic and Social Research Institute (ESRI). [Downloadable!]
  5. Lambrelli, D & O’Donnell, O, 2009. "Why Does the Utilization of Pharmaceuticals Vary So Much Across Europe? Evidence from Micro Data on Older Europeans," Health, Econometrics and Data Group (HEDG) Working Papers 09/06, HEDG, c/o Department of Economics, University of York. [Downloadable!]
  6. Nolan, Anne, 2006. "Evaluating the Impact of Eligibility for Free Care on the Use of GP Services in Ireland: A Difference-in-Difference Matching Approach," Papers HRBWP25, Economic and Social Research Institute (ESRI). [Downloadable!]
  7. Anne Nolan, 2009. "Eligibility for Free Primary Care and Avoidable Hospitalisations in Ireland," Papers WP296, Economic and Social Research Institute (ESRI). [Downloadable!]
  8. David Madden, 2007. "Doctors' Fees in Ireland Following the Change in Reimbursement: Did they Jump?," The Economic and Social Review, Economic and Social Studies, vol. 38(2), pages 259-274. [Downloadable!]
    Other versions:
  9. Pat McGregor & Pat McKee & Ciaran O’Neill, 2006. "GP Utilisation in Northern Ireland - Exploiting the Gatekeeper Function," The Economic and Social Review, Economic and Social Studies, vol. 37(1), pages 71-90. [Downloadable!]
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