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Association between physician density and health care consumption: A systematic review of the evidence

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  • Léonard, Christian
  • Stordeur, Sabine
  • Roberfroid, Dominique

Abstract

Background Supplier-induced demand (SID) for health care could be a crucial factor of rising health expenditures. However, there is thus far no consensus on the topic.Objective To assess how physician density (physician-to-population ratio) and health care consumption correlate.Methods A systematic review of studies retrieved through electronic databases: Medline, Econlit, PsychINFO and Embase. Search, inclusion and quality appraisal were based on standard procedures and applied independently by two researchers.Results Twenty-five studies, generally of moderate quality, were included. Despite a substantial heterogeneity in study design and data modelling, a significant association between physician density and health care consumption was consistently observed. However, estimates varied according to a number of method parameters such as the definition of the dependent variable (physician volume or care intensity), the geographical entity or the medical specialty under consideration, and the adjustment for confounding factors.Conclusions The exact importance of SID and the underlying motivations remain poorly understood. We discuss technical issues for better SID assessment. In the absence of more accurate information, limiting physician supply as a measure of cost containment should also be considered cautiously.

Suggested Citation

  • Léonard, Christian & Stordeur, Sabine & Roberfroid, Dominique, 2009. "Association between physician density and health care consumption: A systematic review of the evidence," Health Policy, Elsevier, vol. 91(2), pages 121-134, July.
  • Handle: RePEc:eee:hepoli:v:91:y:2009:i:2:p:121-134
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    7. Alexander Ahammer & Ivan Zilic, 2017. "Do Financial Incentives Alter Physician Prescription Behavior? Evidence From Random Patient-GP Allocations," Economics working papers 2017-02, Department of Economics, Johannes Kepler University Linz, Austria.
    8. Rudy Douven & Remco Mocking & Ilaria Mosca, 2012. "The Effect of Physician Fees and Density Differences on Regional Variation in Hospital Treatments," CPB Discussion Paper 208, CPB Netherlands Bureau for Economic Policy Analysis.
    9. Lin, Yen-Ju & Tian, Wei-Hua & Chen, Chun-Chih, 2011. "Urbanization and the utilization of outpatient services under National Health Insurance in Taiwan," Health Policy, Elsevier, vol. 103(2), pages 236-243.
    10. Trybou, Jeroen & De Regge, Melissa & Gemmel, Paul & Duyck, Philippe & Annemans, Lieven, 2014. "Effects of physician-owned specialized facilities in health care: A systematic review," Health Policy, Elsevier, vol. 118(3), pages 316-340.
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    12. Shmueli, Amir & Nissan-Engelcin, Esti, 2013. "Local availability of physicians' services as a tool for implicit risk selection," Social Science & Medicine, Elsevier, vol. 84(C), pages 53-60.
    13. Ian McRae & James Butler, 2014. "Supply and demand in physician markets: a panel data analysis of GP services in Australia," International Journal of Health Economics and Management, Springer, vol. 14(3), pages 269-287, September.

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