IDEAS home Printed from https://ideas.repec.org/a/eee/hepoli/v106y2012i3p257-268.html
   My bibliography  Save this article

Physician density in a two-tiered health care system

Author

Listed:
  • Gächter, Martin
  • Schwazer, Peter
  • Theurl, Engelbert
  • Winner, Hannes

Abstract

We investigate the density of non-contract (private) physicians in a two-tiered health care system, i.e., one with co-existing public and private health care providers. In particular, we analyze how the densities of private and public suppliers of outpatient health care (general practitioners and specialists) are related to each other. Using a panel of 121 Austrian districts between 2002 and 2008, we apply a Hausman–Taylor estimator, which allows to treat each of these densities as endogenous. We find that the density of non-contract specialists is positively associated with the density of non-contract general practitioners, but not significantly related to the density of contract general practitioners. We also observe a negative relationship between the densities of non-contract and contract general practitioners and the ones of non-contract and contract specialists, indicating competitive forces between the private and the public sector of the outpatient health care provision in Austria. Our results contribute to the ongoing debate on the role of non-contract physicians for health care provision in Austria.

Suggested Citation

  • Gächter, Martin & Schwazer, Peter & Theurl, Engelbert & Winner, Hannes, 2012. "Physician density in a two-tiered health care system," Health Policy, Elsevier, vol. 106(3), pages 257-268.
    • Handle: RePEc:eee:hepoli:v:106:y:2012:i:3:p:257-268
    DOI: 10.1016/j.healthpol.2012.04.012
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0168851012001170
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.healthpol.2012.04.012?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to look for a different version below or search for a different version of it.

    Other versions of this item:

    References listed on IDEAS

    as
    1. Capps, Cory & Dranove, David & Lindrooth, Richard C., 2010. "Hospital closure and economic efficiency," Journal of Health Economics, Elsevier, vol. 29(1), pages 87-109, January.
    2. Martin Gaynor & Deborah Haas-Wilson, 1999. "Change, Consolidation, and Competition in Health Care Markets," Journal of Economic Perspectives, American Economic Association, vol. 13(1), pages 141-164, Winter.
    3. Jean Marie Abraham & Martin Gaynor & William B. Vogt, 2007. "Entry And Competition In Local Hospital Markets," Journal of Industrial Economics, Wiley Blackwell, vol. 55(2), pages 265-288, June.
    4. Hausman, Jerry A & Taylor, William E, 1981. "Panel Data and Unobservable Individual Effects," Econometrica, Econometric Society, vol. 49(6), pages 1377-1398, November.
    5. Davidson, Russell & MacKinnon, James G., 1993. "Estimation and Inference in Econometrics," OUP Catalogue, Oxford University Press, number 9780195060119.
    6. Lin, Ge & Rosenthal, Thomas C. & Horwitz, Mary, 1997. "Physician location survey: Self-reported and census-defined rural/urban locations," Social Science & Medicine, Elsevier, vol. 44(11), pages 1761-1766, June.
    7. Bolduc, Denis & Fortin, Bernard & Fournier, Marc-Andre, 1996. "The Effect of Incentive Policies on the Practice Location of Doctors: A Multinomial Probit Analysis," Journal of Labor Economics, University of Chicago Press, vol. 14(4), pages 703-732, October.
    8. Engelbert Theurl & Hannes Winner, 2011. "The male–female gap in physician earnings: evidence from a public health insurance system," Health Economics, John Wiley & Sons, Ltd., vol. 20(10), pages 1184-1200, October.
    9. Bresnahan, Timothy F & Reiss, Peter C, 1991. "Entry and Competition in Concentrated Markets," Journal of Political Economy, University of Chicago Press, vol. 99(5), pages 977-1009, October.
    10. Propper, Carol, 2000. "The demand for private health care in the UK," Journal of Health Economics, Elsevier, vol. 19(6), pages 855-876, November.
    11. Joseph P. Newhouse & Albert P. Williams & Bruce W. Bennett & William B. Schwartz, 1982. "Does the Geographical Distribution of Physicians Reflect Market Failure?," Bell Journal of Economics, The RAND Corporation, vol. 13(2), pages 493-505, Autumn.
    12. Catherine Schaumans & Frank Verboven, 2008. "Entry and regulation: evidence from health care professions," RAND Journal of Economics, RAND Corporation, vol. 39(4), pages 949-972, December.
    13. Noether, Monica, 1986. "The Growing Supply of Physicians: Has the Market Become More Competitive?," Journal of Labor Economics, University of Chicago Press, vol. 4(4), pages 503-537, October.
    14. Jiang, H. Joanna & Begun, James W., 2002. "Dynamics of change in local physician supply: an ecological perspective," Social Science & Medicine, Elsevier, vol. 54(10), pages 1525-1541, May.
    15. Timothy F. Bresnahan & Peter C. Reiss, 1990. "Entry in Monopoly Market," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 57(4), pages 531-553.
    16. Baumgardner, James R, 1988. "Physicians' Services and the Division of Labor across Local Markets," Journal of Political Economy, University of Chicago Press, vol. 96(5), pages 948-982, October.
    17. Atella, Vincenzo & Deb, Partha, 2008. "Are primary care physicians, public and private sector specialists substitutes or complements? Evidence from a simultaneous equations model for count data," Journal of Health Economics, Elsevier, vol. 27(3), pages 770-785, May.
    18. Kristiansen, Ivar Sønbø & Førde, Olav Helge, 1992. "Medical specialists' choice of location: The role of geographical attachment in Norway," Social Science & Medicine, Elsevier, vol. 34(1), pages 57-62, January.
    19. Amemiya, Takeshi & MaCurdy, Thomas E, 1986. "Instrumental-Variable Estimation of an Error-Components Model," Econometrica, Econometric Society, vol. 54(4), pages 869-880, July.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Luiz Flavio Andrade & Thomas Rapp & Christine Sevilla-Dedieu, 2016. "Exploring the determinants of endocrinologist visits by patients with diabetes," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(9), pages 1173-1184, December.
    2. Pedro Ramos & Hélio Alves & Paulo Guimarães & Maria A. Ferreira, 2017. "Junior doctors’ medical specialty and practice location choice: simulating policies to overcome regional inequalities," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(8), pages 1013-1030, November.
    3. Gächter, Martin & Schwazer, Peter & Theurl, Engelbert & Winner, Hannes, 2012. "Regional density of private dentists: Empirical evidence from Austria," Working Papers in Economics 2012-8, University of Salzburg.
    4. Martin Gaechter & Peter Schwazer & Engelbert Theurl, 2013. "Entry into the Physicians’ Market: Empirical Evidence from the Outpatient Sector in Austria," DANUBE: Law and Economics Review, European Association Comenius - EACO, issue 4, pages 245-260, December.
    5. Mougeot, Michel & Naegelen, Florence, 2018. "Achieving a fair geographical distribution of health-care resources," Regional Science and Urban Economics, Elsevier, vol. 70(C), pages 384-392.
    6. Michael Kuhn & Robert Nuscheler, 2020. "Saving the public from the private? Incentives and outcomes in dual practice," Journal of Public Economic Theory, Association for Public Economic Theory, vol. 22(4), pages 1120-1150, August.
    7. Kuhn, Michael & Ochsen, Carsten, 2019. "Population change and the regional distribution of physicians," The Journal of the Economics of Ageing, Elsevier, vol. 14(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Martin Gaechter & Peter Schwazer & Engelbert Theurl, 2013. "Entry into the Physicians’ Market: Empirical Evidence from the Outpatient Sector in Austria," DANUBE: Law and Economics Review, European Association Comenius - EACO, issue 4, pages 245-260, December.
    2. Gaynor, Martin & Town, Robert J., 2011. "Competition in Health Care Markets," Handbook of Health Economics, in: Mark V. Pauly & Thomas G. Mcguire & Pedro P. Barros (ed.), Handbook of Health Economics, volume 2, chapter 0, pages 499-637, Elsevier.
    3. Martin Gächter & Peter Schwazer & Engelbert Theurl, 2011. "Entry and Exit of Physicians in a two-tiered public/private Health Care System," Working Papers 2011-05, Faculty of Economics and Statistics, Universität Innsbruck.
    4. Martin Lábaj & Peter Silanič & Christoph Weiss & Biliana Yontcheva, 2018. "Market structure and competition in the healthcare industry," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(8), pages 1087-1110, November.
    5. Noailly, Joëlle & Nahuis, Richard, 2010. "Entry and competition in the Dutch notary profession," International Review of Law and Economics, Elsevier, vol. 30(2), pages 178-185, June.
    6. Martin Lábaj & Peter Mandžak, 2022. "Entry and Competition of Healthcare Providers in Slovakia: A Spatial Analysis," Journal of Economics / Ekonomicky casopis, Institute of Economic Research, Slovak Academy of Sciences, vol. 70(3), pages 211-236, March.
    7. Martin Lábaj & Alzbeta Siskovicova & Barbora Skalicanova & Peter Silanic & Christoph Weiss & Biliana Yontcheva, 2015. "Market Structure and Competition in the Health-care Industry: Results from a Transition Economy," Department of Economic Policy Working Paper Series 010, Department of Economic Policy, Faculty of National Economy, University of Economics in Bratislava.
    8. Kuhn, Michael & Ochsen, Carsten, 2019. "Population change and the regional distribution of physicians," The Journal of the Economics of Ageing, Elsevier, vol. 14(C).
    9. Isabelle Clerc & Olivier L’Haridon & Alain Paraponaris & Camelia Protopopescu & Bruno Ventelou, 2012. "Fee-for-service payments and consultation length in general practice: a work--leisure trade-off model for French GPs," Applied Economics, Taylor & Francis Journals, vol. 44(25), pages 3323-3337, September.
    10. Martin Lábaj & Karol Morvay & Peter Silanič & Christoph Weiss & Biliana Yontcheva, 2018. "Market structure and competition in transition: results from a spatial analysis," Applied Economics, Taylor & Francis Journals, vol. 50(15), pages 1694-1715, March.
    11. Catherine Schaumans & Frank Verboven, 2015. "Entry and Competition in Differentiated Products Markets," The Review of Economics and Statistics, MIT Press, vol. 97(1), pages 195-209, March.
    12. Liu, An-Hsiang & Siebert, Ralph B., 2022. "The competitive effects of declining entry costs over time: Evidence from the static random access memory market," International Journal of Industrial Organization, Elsevier, vol. 80(C).
    13. Fitzová, Hana & Kališ, Richard & Pařil, Vilém & Fila, Milan, 2024. "Entry and competition in the European bike-sharing industry," Transport Policy, Elsevier, vol. 149(C), pages 100-107.
    14. Iris Grant & Iris Kesternich & Johannes Van Biesebroeck, 2022. "Entry Decisions And Asymmetric Competition Between Non‐Profit And For‐Profit Homes In The Long‐Term Care Market," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 63(2), pages 631-670, May.
    15. Sandra Nocera & Gabrielle Wanzenried, 2002. "On the Dynamics of Physician Density; Theory and Empirical Evidence for Switzerland," Diskussionsschriften dp0208, Universitaet Bern, Departement Volkswirtschaft.
    16. Isabel Correia & Paula Veiga, 2010. "Geographic distribution of physicians in Portugal," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(4), pages 383-393, August.
    17. Catherine Schaumans & Frank Verboven, 2008. "Entry and regulation: evidence from health care professions," RAND Journal of Economics, RAND Corporation, vol. 39(4), pages 949-972, December.
    18. Wendy Carlin & Steven Fries & Mark Schaffer & Paul Seabright, 2001. "Competition and Enterprise Performance in Transition Economies: Evidence from a Cross-country Survey," William Davidson Institute Working Papers Series 376, William Davidson Institute at the University of Michigan.
    19. Gayle, Philip G. & Harrison, Teresa D. & Thornton, Jeremy, 2017. "Entry, donor market size, and competitive conduct among nonprofit firms," International Journal of Industrial Organization, Elsevier, vol. 50(C), pages 294-318.
    20. Wendy Carlin & Steven Fries & Mark Schaffer & Paul Seabright, 2001. "Competition and Enterprise Performance in Transition Economies from a Cross-Country Survey," CERT Discussion Papers 0101, Centre for Economic Reform and Transformation, Heriot Watt University.

    More about this item

    Keywords

    Competition in health care markets; Physician location; Panel econometrics;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • L23 - Industrial Organization - - Firm Objectives, Organization, and Behavior - - - Organization of Production
    • C23 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Models with Panel Data; Spatio-temporal Models

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:hepoli:v:106:y:2012:i:3:p:257-268. See general information about how to correct material in RePEc.

    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 CitEc recognized a bibliographic reference but did not link an item in RePEc 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 RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu or the person in charge (email available below). General contact details of provider: http://www.elsevier.com/locate/healthpol .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.