Exit, Choice Or Loyalty: Patient Driven Competition In Primary Care
This paper analyses the potential costs and benefits from patient driven competition between GPs and specialists by comparing gate-keeping with direct access to specialist care. The two access rules are compared under fee-for-service and capitation, on their performance at minimizing both total financial costs and patients' opportunity cost of time in care. To analyse the social cost of patients' potential access mistakes, two types of illnesses are considered, with two levels of severity and an equal probability for each of the four events. The results generated under information symmetry show that gate-keeping always dominates in terms of minimizing financial cost. Results are extended to show that under patients' heterogeneity with respect to time preferences, allocative efficiency can be enhanced in gate-keeping by giving the patient the option to seek a specialist directly, provided he bears the extra cost. When turning to information asymmetry, results are reversed, and direct access is shown to be more cost effective. This is due to patients' ability to constrain providers' opportunistic behaviour by 'voting with their feet'. Beyond increasing allocative efficiency, patient choice is therefore found, under certain conditions, to contribute towards enhancing productive efficiency. Finally, introducing co-payments to share the financial risk associated with direct access potentially weakens patients' ability to curb providers' strategic behaviour. Under information asymmetry, direct access to specialist care should therefore remain free if patient's disutility in time in care is linear. When it is instead increasing, we show that a co-payment becomes necessary to curb specialists' information rent. Finally, under information asymmetry, the mixed solution (gate-keeping with optional direct access) improves on pure gate-keeping but is still suboptimal. Copyright 2007 The Authors Journal compilation � CIRIEC 2007.
If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
As the access to this document is restricted, you may want to look for a different version under "Related research" (further below) or search for a different version of it.
Volume (Year): 78 (2007)
Issue (Month): 4 (December)
|Contact details of provider:|| Web page: http://www.blackwellpublishing.com/journal.asp?ref=1370-4788|
|Order Information:||Web: http://www.blackwellpublishing.com/subs.asp?ref=1370-4788|
When requesting a correction, please mention this item's handle: RePEc:bla:annpce:v:78:y:2007:i:4:p:501-535. See general information about how to correct material in RePEc.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Wiley-Blackwell Digital Licensing)or (Christopher F. Baum)
If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.
If references are entirely missing, you can add them using this form.
If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.
If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.
Please note that corrections may take a couple of weeks to filter through the various RePEc services.