Gatekeeping versus direct-access when patient information matters
AbstractWe develop a principal-agent model in which the health authority acts as a principal for both a patient and a general practitioner (GP). The goal of the paper is to weigh the merits of gatekeeping versus non-gatekeeping approaches to health care when patient self-health information and patient pressure on GPs to provide referrals for specialized care are considered. We find that, when GPs incentives matter, a non-gatekeeping system is preferable only when (i) patient pressure to refer is sufficiently high and (ii) the quality of the patient's self-health information is neither highly inaccurate (in which case the patient's self-referral will be very inefficient) nor highly accurate (in which case the GP's agency problem will be very costly). Copyright © 2009 John Wiley & Sons, Ltd.
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Bibliographic InfoArticle provided by John Wiley & Sons, Ltd. in its journal Health Economics.
Volume (Year): 19 (2010)
Issue (Month): 6 ()
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Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749
Other versions of this item:
- Paula González, 2008. "Gatekeeping versus Direct-Access when Patient Information Matters," Working Papers 2008-05, FEDEA.
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- 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.
- Marinoso, Begona Garcia & Jelovac, Izabela, 2003. "GPs' payment contracts and their referral practice," Journal of Health Economics, Elsevier, vol. 22(4), pages 617-635, July.
- Kroneman, Madelon W. & Maarse, Hans & Zee, Jouke van der, 2006. "Direct access in primary care and patient satisfaction: A European study," Health Policy, Elsevier, vol. 76(1), pages 72-79, March.
- Dusheiko, Mark & Gravelle, Hugh & Yu, Ning & Campbell, Stephen, 2007. "The impact of budgets for gatekeeping physicians on patient satisfaction: Evidence from fundholding," Journal of Health Economics, Elsevier, vol. 26(4), pages 742-762, July.
- Iversen, Tor & Luras, Hilde, 2000. "Economic motives and professional norms: the case of general medical practice," Journal of Economic Behavior & Organization, Elsevier, vol. 43(4), pages 447-470, December.
- Scott, Anthony, 2000. "Economics of general practice," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 22, pages 1175-1200 Elsevier.
- Erik Schokkaert & Carine Van de Voorde, 2005. "Health care reform in Belgium," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages S25-S39.
- Kurt R. Brekke & Robert Nuscheler & Odd Rune Straume, 2005.
"Gatekeeping in Health Care,"
CESifo Working Paper Series
1552, CESifo Group Munich.
- Brekke, Kurt R. & Nuscheler, Robert, 2003. "Gatekeeping in health care," Working Papers in Economics 10/03, University of Bergen, Department of Economics.
- Odd Rune Straume & Kurt Brekke & Robert Nuscheler, 2004. "Gatekeeping In Health Care," Royal Economic Society Annual Conference 2004 83, Royal Economic Society.
- Pedro Pita Barros, 1998. "The black box of health care expenditure growth determinants," Health Economics, John Wiley & Sons, Ltd., vol. 7(6), pages 533-544.
- George France & Francesco Taroni & Andrea Donatini, 2005. "The Italian health-care system," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages S187-S202.
- Karlsson, Martin, 2007. "Quality incentives for GPs in a regulated market," Journal of Health Economics, Elsevier, vol. 26(4), pages 699-720, July.
- Damien S.Eldridge, 2013.
"A shirking theory of referrals,"
2013.01, School of Economics, La Trobe University.
- Ching-to Albert MA & Tor Iversen, 2010.
"Market conditions and general practitioners’ referrals,"
Boston University - Department of Economics - Working Papers Series
WP2010-023, Boston University - Department of Economics.
- Tor Iversen & Ching-to Ma, 2011. "Market conditions and general practitioners’ referrals," International Journal of Health Care Finance and Economics, Springer, vol. 11(4), pages 245-265, December.
- Tor Iversen & Ching-to Albert Ma, . "Market Conditions and General Practitioners' Referrals," Boston University - Department of Economics - Working Papers Series wp2009-009, Boston University - Department of Economics.
- Iversen, Tor & Ma, Albert, 2009. "Market Conditions and General Practitioners’ Referrals," HERO On line Working Paper Series 2009:8, Oslo University, Health Economics Research Programme.
- Marie Allard & Izabela Jelovac & Pierre-Thomas Léger, 2010.
"Physicians self selection of a payment mechanism: Capitation versus fee-for-service,"
- Marie Allard & Izabela Jelovac & Pierre-Thomas Léger, 2010. "Physicians self selection of a payment mechanism: Capitation versus fee-for-service," Working Papers 1024, Groupe d'Analyse et de Théorie Economique (GATE), Centre national de la recherche scientifique (CNRS), Université Lyon 2, Ecole Normale Supérieure.
- Allard, Marie & Jelovac, Izabela & Léger, Pierre Thomas, 2011.
"Treatment and referral decisions under different physician payment mechanisms,"
Journal of Health Economics,
Elsevier, vol. 30(5), pages 880-893.
- Marie Allard & Izabela Jelovac & Pierre-Thomas Léger, 2011. "Treatment and referral decisions under different physician payment mechanisms," Post-Print halshs-00650933, HAL.
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