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Competition, prices, and quality in the market for physician consultations

Author

Listed:
  • Hugh Gravelle

    (Centre for Health Economics, University of York, UK)

  • Anthony Scott

    (Melbourne Institute for Economic and Social Research, The University of Melbourne, Australia)

  • Peter Sivey

    (Melbourne Institute for Economic and Social Research, The University of Melbourne, Australia)

  • Jongsay Yong

    (Melbourne Institute for Economic and Social Research, The University of Melbourne, Australia)

Abstract

Prices for consultations with General Practitioners (GPs) in Australia are unregulated, and patients pay the difference between the price set by the GP and a fixed reimbursement from the national taxfunded Medicare insurance scheme. We construct a Vickrey-Salop model of GP price and quality competition and test its predictions using a dataset with individual GP-level data on prices, the proportion of patients who are charged no out-of-pocket fee, average consultation length, and characteristics of the GPs, their practices and their local areas. We measure the competition to which the GP is exposed by the distance to other GPs and allow for the endogeneity of GP location decisions with measures of area characteristics and area fixed-effects. Within areas, GPs with more distant competitors charge higher prices and a smaller proportion of their patients make no out-ofpocket payment. GPs with more distant competitors also have shorter consultations, though the effect is small and statistically insignificant.

Suggested Citation

  • Hugh Gravelle & Anthony Scott & Peter Sivey & Jongsay Yong, 2013. "Competition, prices, and quality in the market for physician consultations," Working Papers 089cherp, Centre for Health Economics, University of York.
  • Handle: RePEc:chy:respap:89cherp
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    References listed on IDEAS

    as
    1. Brekke, Kurt R. & Siciliani, Luigi & Straume, Odd Rune, 2010. "Price and quality in spatial competition," Regional Science and Urban Economics, Elsevier, vol. 40(6), pages 471-480, November.
    2. Gaynor, Martin & Town, Robert J., 2011. "Competition in Health Care Markets," Handbook of Health Economics, in: Mark V. Pauly & Thomas G. Mcguire & Pedro P. Barros (ed.), Handbook of Health Economics, volume 2, chapter 0, pages 499-637, Elsevier.
    3. Elizabeth Savage & Glenn Jones, 2004. "An Analysis of the General Practice Access Scheme on GP Incomes, Bulk Billing and Consumer Copayments," Australian Economic Review, The University of Melbourne, Melbourne Institute of Applied Economic and Social Research, vol. 37(1), pages 31-40, March.
    4. Catherine Schaumans & Frank Verboven, 2008. "Entry and regulation: evidence from health care professions," RAND Journal of Economics, RAND Corporation, vol. 39(4), pages 949-972, December.
    5. McKnight, Robin, 2007. "Medicare balance billing restrictions: Impacts on physicians and beneficiaries," Journal of Health Economics, Elsevier, vol. 26(2), pages 326-341, March.
    6. Daniel P. Kessler & Mark B. McClellan, 2000. "Is Hospital Competition Socially Wasteful?," The Quarterly Journal of Economics, Oxford University Press, vol. 115(2), pages 577-615.
    7. Timothy Gunning & Robin Sickles, 2013. "Competition and market power in physician private practices," Empirical Economics, Springer, vol. 44(2), pages 1005-1029, April.
    8. Steven C. Salop, 1979. "Monopolistic Competition with Outside Goods," Bell Journal of Economics, The RAND Corporation, vol. 10(1), pages 141-156, Spring.
    9. Raphael Thomadsen, 2005. "The Effect of Ownership Structure on Prices in Geographically Differentiated Industries," RAND Journal of Economics, The RAND Corporation, vol. 36(4), pages 908-929, Winter.
    10. Propper, Carol & Burgess, Simon & Green, Katherine, 2004. "Does competition between hospitals improve the quality of care?: Hospital death rates and the NHS internal market," Journal of Public Economics, Elsevier, vol. 88(7-8), pages 1247-1272, July.
    11. John Schneider & Pengxiang Li & Donald Klepser & N. Peterson & Timothy Brown & Richard Scheffler, 2008. "The effect of physician and health plan market concentration on prices in commercial health insurance markets," International Journal of Health Economics and Management, Springer, vol. 8(1), pages 13-26, March.
    12. Gaynor, Martin & Vogt, William B, 2003. "Competition among Hospitals," RAND Journal of Economics, The RAND Corporation, vol. 34(4), pages 764-785, Winter.
    13. Marco Alderighi & Claudio A. Piga, 2012. "Localized Competition, Heterogeneous Firms and Vertical Relations," Journal of Industrial Economics, Wiley Blackwell, vol. 60(1), pages 46-74, March.
    14. Wenda Yan & Terence Chai Cheng & Anthony Scott & Catherine M. Joyce & John Humphreys & Guyonne Kalb & Anne Leahy, 2011. "Medicine in Australia: Balancing Employment and Life (MABEL)," Australian Economic Review, The University of Melbourne, Melbourne Institute of Applied Economic and Social Research, vol. 44(1), pages 102-112, March.
    15. Glazer, Jacob & Glazer, Jacob & McGuire, Thomas G., 1993. "Should physicians be permitted to 'balance bill' patients?," Journal of Health Economics, Elsevier, vol. 12(3), pages 239-258, October.
    16. Olivier L'Haridon & Alain Panaponaris & Camelia Protopopescu & Bruno Ventelou, 2008. "Length Of Gp Consultation Within Two Payment Schemes," Working Papers halshs-00347449, HAL.
    17. Martin Gaynor & Rodrigo Moreno-Serra & Carol Propper, 2013. "Death by Market Power: Reform, Competition, and Patient Outcomes in the National Health Service," American Economic Journal: Economic Policy, American Economic Association, vol. 5(4), pages 134-166, November.
    18. Carol Propper & Simon Burgess & Denise Gossage, 2008. "Competition and Quality: Evidence from the NHS Internal Market 1991–9," Economic Journal, Royal Economic Society, vol. 118(525), pages 138-170, January.
    19. W. Bradford & Robert Martin, 2000. "Partnerships, Profit Sharing, and Quality Competition in the Medical Profession," Review of Industrial Organization, Springer;The Industrial Organization Society, vol. 17(2), pages 193-208, September.
    20. Vickrey, William S. & Anderson, Simon P. & Braid, Ralph M., 1999. "Spatial competition, monopolistic competition, and optimum product diversity," International Journal of Industrial Organization, Elsevier, vol. 17(7), pages 953-963, October.
    21. Jeffrey Richardson & Stuart Peacock & Duncan Mortimer, 2006. "Does an increase in the doctor supply reduce medical fees? An econometric analysis of medical fees across Australia," Applied Economics, Taylor & Francis Journals, vol. 38(3), pages 253-266.
    22. Jessica Wolpaw Reyes, 2006. "Do Female Physicians Capture Their Scarcity Value? The Case of OB/GYNs," NBER Working Papers 12528, National Bureau of Economic Research, Inc.
    23. Mark V. Pauly & Mark A. Satterthwaite, 1981. "The Pricing of Primary Care Physicians' Services: A Test of the Role of Consumer Information," Bell Journal of Economics, The RAND Corporation, vol. 12(2), pages 488-506, Autumn.
    24. Bresnahan, Timothy F & Reiss, Peter C, 1991. "Entry and Competition in Concentrated Markets," Journal of Political Economy, University of Chicago Press, vol. 99(5), pages 977-1009, October.
    25. Johar, Meliyanni, 2012. "Do doctors charge high income patients more?," Economics Letters, Elsevier, vol. 117(3), pages 596-599.
    26. Gravelle, Hugh, 1999. "Capitation contracts: access and quality," Journal of Health Economics, Elsevier, vol. 18(3), pages 315-340, June.
    27. Mark V. Pauly & Thomas G. Mcguire & Pedro P. Barros (ed.), 2011. "Handbook of Health Economics," Handbook of Health Economics, Elsevier, volume 2, number 2.
    28. Bresnahan, Timothy F., 1989. "Empirical studies of industries with market power," Handbook of Industrial Organization, in: R. Schmalensee & R. Willig (ed.), Handbook of Industrial Organization, edition 1, volume 2, chapter 17, pages 1011-1057, Elsevier.
    29. Gaynor, Martin & Pauly, Mark V, 1990. "Compensation and Productive Efficiency of Partnerships: Evidence from Medical Group Practice," Journal of Political Economy, University of Chicago Press, vol. 98(3), pages 544-573, June.
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    More about this item

    Keywords

    Competition; Prices; Quality of care; Primary care; Doctors;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • L1 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance

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