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The Effect of Budgets on Doctor Behaviour: Evidence From A Natural Experiment

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Author Info
Mark Dusheiko
Hugh Gravelle
Rowena Jacobs
Peter C Smith

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Abstract

In many health care systems primary care physicians act as 'gatekeepers' to secondary care. We investigates the impact of the UK fundholding scheme under which general practices could elect to hold a budget to meet the costs of elective surgery for their patients. We use a differences in differences methodology on a large four year panel of English general practices before and after the abolition of fundholding. Fundholding incentives reduced fundholder elective admission rates by 3.3% and accounted for 57% of the difference between fundholder and nonfundholder elective admissions, with 43% a selection effect due to unobservable differences in practice characteristics. Fundholding had no effect on emergency admissions.

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Paper provided by Department of Economics, University of York in its series Discussion Papers with number 03/04.

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Handle: RePEc:yor:yorken:03/04

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Related research
Keywords: Budgets; Health care; Fundholding; Admission rates;

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Find related papers by JEL classification:
I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
  1. Gravelle, Hugh & Dusheiko, Mark & Sutton, Matthew, 2002. "The demand for elective surgery in a public system: time and money prices in the UK National Health Service," Journal of Health Economics, Elsevier, vol. 21(3), pages 423-449, May. [Downloadable!] (restricted)
  2. Hugh Gravelle & Peter C. Smith & Ana Xavier, . "Waiting Times and Waiting Lists: A Model of the Market for Elective Surgery," Discussion Papers 00/27, Department of Economics, University of York. [Downloadable!]
  3. Propper, Carol & Croxson, Bronwyn & Shearer, Arran, 2002. "Waiting times for hospital admissions: the impact of GP fundholding," Journal of Health Economics, Elsevier, vol. 21(2), pages 227-252, March. [Downloadable!] (restricted)
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  4. 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. [Downloadable!]
  5. Martin, Stephen & Smith, Peter C., 1999. "Rationing by waiting lists: an empirical investigation," Journal of Public Economics, Elsevier, vol. 71(1), pages 141-164, January. [Downloadable!] (restricted)
  6. Propper, Carol & Wilson, Deborah & Soderlund, Neil, 1998. "The effects of regulation and competition in the NHS internal market: the case of general practice fundholder prices," Journal of Health Economics, Elsevier, vol. 17(6), pages 645-673, December. [Downloadable!] (restricted)
  7. 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. [Downloadable!] (restricted)
  8. Lindsay, Cotton M & Feigenbaum, Bernard, 1984. "Rationing by Waiting Lists," American Economic Review, American Economic Association, vol. 74(3), pages 404-17, June. [Downloadable!] (restricted)
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Cited by:
(explanations, Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.)

  1. Francisco J. Gomes & Laurence J. Kotlikoff & Luis M. Viceira, 2007. "The Excess Burden Of Government Indecision," Boston University - Department of Economics - Working Papers Series WP2007-004, Boston University - Department of Economics. [Downloadable!]
    Other versions:
  2. Hugh Gravelle & Matt Sutton & Ada Ma, 2007. "Doctor Behaviour Under a Pay for Performance Contract: Evidence from the Quality and Outcomes Framework," Working Papers 028cherp, Centre for Health Economics, University of York. [Downloadable!]
  3. Karen Bloor, 2005. "Motivation, agency and public policy: of knights and knaves, pawns and queens, by Julian Le Grand. Oxford University Press, Oxford, 2003. No. of pages: 191. ISBN 0-19-926699-9," Health Economics, John Wiley & Sons, Ltd., vol. 14(1), pages 101-102. [Downloadable!]
  4. Philippe Chone & Ching-to Albert Ma, 2005. "Asymmetric Information from Physician Agency:Optimal Payment and Healthcare Quantity," Boston University - Department of Economics - Working Papers Series WP2005-006, Boston University - Department of Economics. [Downloadable!]
    Other versions:
  5. David Madden & Anne Nolan & Brian Nolan, 2005. "GP reimbursement and visiting behaviour in Ireland," Health Economics, John Wiley & Sons, Ltd., vol. 14(10), pages 1047-1060. [Downloadable!]
    Other versions:
  6. Philippe Chone & Ching-to Albert Ma, 2007. "Optimal Health Care Contracts under Physician Agency," Boston University - Department of Economics - Working Papers Series WP2007-041, Boston University - Department of Economics, revised Sep 2007. [Downloadable!]
  7. Mark Dusheiko & Hugh Gravelle & Rowena Jacobs, 2004. "The effect of practice budgets on patient waiting times: allowing for selection bias," Health Economics, John Wiley & Sons, Ltd., vol. 13(10), pages 941-958. [Downloadable!]
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