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A study of income-motivated behavior among general practitioners in the Norwegian list patient system

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  • Iversen, Tor

    ()
    (Institute of Health Management and Health Economics)

Abstract

In the Norwegian capitation system each general practitioner (GP) has a personal list of patients. The payment system is a mix of a capitation fee and fee-for-service. From a model of a GP’s decisions we derive the optimal practice profile contingent on whether a GP experiences a shortage of patients or not. We also find the conditions for whether a GP, who experiences a shortage of patients, is likely to increase the number of services he provides to his patients. Data give us the opportunity to reveal patient shortage, i.e. a positive difference between a GP’s preferred and actual list size, at the individual practice level. From the analysis of 2587 Norwegian GPs (out of a total 3650) the main result is that patient shortage has a positive effect on a GP’s intensity of service provision and hence, on the income per listed person. We also find that a GP’s income per listed person is influenced by the composition of the list according to indicators of need for services, and of accessibility according to the GP density in the municipality. These results are also valid when possible selection bias is accounted for, although the magnitude of the effects is then smaller.

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File URL: http://www.hero.uio.no/publicat/2005/HERO2005_8.pdf
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Bibliographic Info

Paper provided by Oslo University, Health Economics Research Programme in its series HERO On line Working Paper Series with number 2005:8.

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Length: 29 pages
Date of creation: 07 Jun 2009
Date of revision:
Handle: RePEc:hhs:oslohe:2005_008

Contact details of provider:
Postal: HERO / Institute of Health Management and Health Economics P.O. Box 1089 Blindern, N-0317 Oslo, Norway
Phone: 2307 5309
Fax: 2307 5310
Email:
Web page: http://www.hero.uio.no/eng.html
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Related research

Keywords: economic motives; capitation; general practice; patient shortage; service provision;

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References

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  1. Joseph P. Newhouse, 2004. "Pricing the Priceless: A Health Care Conundrum," MIT Press Books, The MIT Press, edition 1, volume 1, number 0262640589, December.
  2. 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.
  3. 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.
  4. Iversen, Tor, 2004. "The effects of a patient shortage on general practitioners' future income and list of patients," Journal of Health Economics, Elsevier, vol. 23(4), pages 673-694, July.
  5. McGuire, Thomas G., 2000. "Physician agency," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 9, pages 461-536 Elsevier.
  6. 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.
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Cited by:
  1. Godager, Geir & Iversen, Tor & Ma , Ching-To Albert, 2009. "Service motives and profit incentives among physicans," HERO On line Working Paper Series 2007:4, Oslo University, Health Economics Research Programme.
  2. Iversen, Tor & Lurås, Hilde, 2011. "Patient switching in general practice," Journal of Health Economics, Elsevier, vol. 30(5), pages 894-903.
  3. Sabine Jokisch & Laurence J. Kotlikoff, 2007. "Simulating the Dynamic Macroeconomic and Microeconomic Effects of the FairTax1," Boston University - Department of Economics - Working Papers Series WP2007-026, Boston University - Department of Economics.

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