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The Gatekeeping Role of General Practitioners. Does Patients' Information Matter?

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  • Paula González

    ()
    (Department of Economics, Universidad Pablo de Olavide)

Abstract

We 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 investigate the relative merits of gatekeeping and non-gatekeeping systems and to analyze the role of the quality of patient information and referral pressure in determining which model dominates. We find that, whenever GPs incentives matter, non-gatekeeping is better only if there is a sufficiently high pressure for referral. At the same time, for a non-gatekeeping system to dominate, the quality of the patient information should not be extreme: neither too bad (patient’ s self-referral would be very inefficient) nor too good (the GP’s agency problem would be very costly).

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File URL: http://www.upo.es/serv/bib/wps/econ0609.pdf
File Function: First version, 2006
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Bibliographic Info

Paper provided by Universidad Pablo de Olavide, Department of Economics in its series Working Papers with number 06.09.

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Length: 31 pages
Date of creation: Mar 2006
Date of revision:
Handle: RePEc:pab:wpaper:06.09

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Keywords: General Practice; Moral hazard; Incentives; Patients’ beliefs; Patients’ pressure; Referrals.;

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References

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  1. Iversen, Tor & Luras, Hilde, 2000. "Economic motives and professional norms: the case of general medical practice," Journal of Economic Behavior & Organization, Elsevier, Elsevier, vol. 43(4), pages 447-470, December.
  2. Brekke, Kurt R. & Nuscheler, Robert & Straume, Odd Rune, 2007. "Gatekeeping in health care," Journal of Health Economics, Elsevier, Elsevier, vol. 26(1), pages 149-170, January.
  3. Paula González, 2004. "Should physicians' dual practice be limited? An incentive approach," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 13(6), pages 505-524.
  4. Izabela Jelovac, 2001. "Physicians' payment contracts, treatment decisions and diagnosis accuracy," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 10(1), pages 9-25.
  5. Scott, Anthony, 2000. "Economics of general practice," Handbook of Health Economics, Elsevier, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 22, pages 1175-1200 Elsevier.
  6. Marinoso, Begona Garcia & Jelovac, Izabela, 2003. "GPs' payment contracts and their referral practice," Journal of Health Economics, Elsevier, Elsevier, vol. 22(4), pages 617-635, July.
  7. Erik Schokkaert & Carine Van de Voorde, 2005. "Health care reform in Belgium," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 14(S1), pages S25-S39.
  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, Elsevier, vol. 79(2), pages 375-398, February.
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Cited by:
  1. Odd Rune Straume & Kurt Brekke & Robert Nuscheler, 2004. "Gatekeeping In Health Care," Royal Economic Society Annual Conference 2004, Royal Economic Society 83, Royal Economic Society.
  2. Tor Iversen & Ching-to Ma, 2011. "Market conditions and general practitioners’ referrals," International Journal of Health Care Finance and Economics, Springer, Springer, vol. 11(4), pages 245-265, December.

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