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 selfhealth 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 very inefficient) nor highly accurate (in which case the GP’s agency problem will be very costly).
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Bibliographic InfoPaper provided by FEDEA in its series Working Papers with number 2008-05.
Date of creation: Jan 2008
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- Paula González, 2010. "Gatekeeping versus direct-access when patient information matters," Health Economics, John Wiley & Sons, Ltd., vol. 19(6), pages 730-754.
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- George France & Francesco Taroni & Andrea Donatini, 2005. "The Italian health-care system," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages S187-S202.
- Erik Schokkaert & Carine Van de Voorde, 2005. "Health care reform in Belgium," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages S25-S39.
- Karlsson, Martin, 2007. "Quality incentives for GPs in a regulated market," Journal of Health Economics, Elsevier, vol. 26(4), pages 699-720, July.
- Brekke, Kurt R. & Nuscheler, Robert, 2003.
"Gatekeeping in health care,"
Working Papers in Economics
10/03, University of Bergen, Department of Economics.
- Kurt R. Brekke & Robert Nuscheler & Odd Rune Straume, 2005. "Gatekeeping in Health Care," CESifo Working Paper Series 1552, CESifo Group Munich.
- Odd Rune Straume & Kurt Brekke & Robert Nuscheler, 2004. "Gatekeeping In Health Care," Royal Economic Society Annual Conference 2004 83, Royal Economic Society.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Damien S Eldridge, 2007.
"A Shirking Theory of Referrals,"
2007.05, School of Economics, La Trobe University.
- Marie Allard & Izabela Jelovac & Pierre-Thomas Léger, 2011.
"Treatment and referral decisions under different physician payment mechanisms,"
- 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, 2010.
"Physicians self selection of a payment mechanism: Capitation versus fee-for-service,"
1024, Groupe d'Analyse et de Théorie Economique (GATE), Centre national de la recherche scientifique (CNRS), Université Lyon 2, Ecole Normale Supérieure.
- Marie Allard & Izabela Jelovac & Pierre-Thomas Léger, 2010. "Physicians self selection of a payment mechanism: Capitation versus fee-for-service," Post-Print halshs-00523370, HAL.
- 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.
- 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.
- 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 Albert Ma, . "Market Conditions and General Practitioners' Referrals," Boston University - Department of Economics - Working Papers Series wp2009-009, Boston University - Department of Economics.
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