Association between physician density and health care consumption: A systematic review of the evidence
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.
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.
References listed on IDEAS
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.:
- Jonathan Gruber & Maria Owings, 1996.
"Physician Financial Incentives and Cesarean Section Delivery,"
RAND Journal of Economics,
The RAND Corporation, vol. 27(1), pages 99-123, Spring.
- Jonathan Gruber & Maria Owings, 1994. "Physician Financial Incentives and Cesarean Section Delivery," NBER Working Papers 4933, National Bureau of Economic Research, Inc.
- Trinquard, S., 2006. "Demande induite par l’offre ambulatoire : un survol de la littérature théorique et empirique," Cahiers du LASER (LASER Working Papers) 2006.20, LASER (Laboratoire de Science Economique de Richter), Faculty of Economics, University of Montpellier 1.
- Mitchell, Jean M. & Sass, Tim R., 1995. "Physician ownership of ancillary services: Indirect demand inducement or quality assurance?," Journal of Health Economics, Elsevier, vol. 14(3), pages 263-289, August.
- McGuire, Thomas G., 2000. "Physician agency," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 9, pages 461-536 Elsevier.
- Nicolas Couderc & Vincent Touzé & Bruno Ventelou, 2001. "Politiques de santé dans un modèle macroéconomique : un exercice de simulation," Revue de l'OFCE, Presses de Sciences-Po, vol. 78(3), pages 209-244.
- Sophie Béjean & Christine Peyron & Renaud Urbinelli, 2007.
"Variations in activity and practice patterns: a French study for GPs,"
- Sophie Béjean & Christine Peyron & Renaud Urbinelli, 2007. "Variations in activity and practice patterns: a French study for GPs," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 8(3), pages 225-236, September.
- Grytten, Jostein & Sorensen, Rune, 2001. "Type of contract and supplier-induced demand for primary physicians in Norway," Journal of Health Economics, Elsevier, vol. 20(3), pages 379-393, May.
- Pauly, Mark V., 1994. "Editorial: A re-examination of the meaning and importance of supplier-induced demand," Journal of Health Economics, Elsevier, vol. 13(3), pages 369-372, October.
- Louis F. Rossiter & Gail R. Wilensky, 1984. "Identification of Physician-Induced Demand," Journal of Human Resources, University of Wisconsin Press, vol. 19(2), pages 231-244.
- Phelps, Charles E., 1986. "Induced demand -- can we ever know its extent?," Journal of Health Economics, Elsevier, vol. 5(4), pages 355-365, December.
- Labelle, Roberta & Stoddart, Greg & Rice, Thomas, 1994. "A re-examination of the meaning and importance of supplier-induced demand," Journal of Health Economics, Elsevier, vol. 13(3), pages 347-368, October.
- Tussing, A. Dale & Wojtowycz, Martha A., 1986. "Physician-induced demand by Irish GPs," Social Science & Medicine, Elsevier, vol. 23(9), pages 851-860, January.
- Iversen, Tor & Luras, Hilde, 2000. "Economic motives and professional norms: the case of general medical practice," Journal of Economic Behavior & Organization, Elsevier, vol. 43(4), pages 447-470, December.
- Laurence J. Kotlikoff & Christian Hagist, 2006. "Health Care Spending: What the Future Will Look Like," Boston University - Department of Economics - Working Papers Series WP2006-026, Boston University - Department of Economics.
- Rune J. Sørensen & Jostein Grytten, 1999. "Competition and supplier-induced demand in a health care system with fixed fees," Health Economics, John Wiley & Sons, Ltd., vol. 8(6), pages 497-508.
- Anthony Scott & Alan Shiell, 1997. "Analysing the effect of competition on General Practitioners' behaviour using a multilevel modelling framework," Health Economics, John Wiley & Sons, Ltd., vol. 6(6), pages 577-588.
- W. David Bradford & Robert E. Martin, 1995. "Supplier-Induced Demand and Quality Competition: An Empirical Investigation," Eastern Economic Journal, Eastern Economic Association, vol. 21(4), pages 491-503, Fall.
- Erik Schokkaert & Carine Van de Voorde, 2005. "Health care reform in Belgium," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages S25-S39.
- Fredrik Carlsen & Jostein Grytten, 1998. "More physicians: improved availability or induced demand?," Health Economics, John Wiley & Sons, Ltd., vol. 7(6), pages 495-508.
- T Rice & R Labelle, 1989. "Do Physicians Induce Demand for Medical Service?," Centre for Health Economics and Policy Analysis Working Paper Series 18, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
- Iversen, Tor, 2004. "The effects of a patient shortage on general practitioners' future income and list of patients," Journal of Health Economics, Elsevier, vol. 23(4), pages 673-694, July.
- Stano, Miron, 1985. "An analysis of the evidence on competition in the physician services markets," Journal of Health Economics, Elsevier, vol. 4(3), pages 197-211, September.
- Cromwell, Jerry & Mitchell, Janet B., 1986. "Physician-induced demand for surgery," Journal of Health Economics, Elsevier, vol. 5(4), pages 293-313, December.
- Stuart Peacock & Jeffrey Richardson, 2007. "Supplier-induced demand: re-examining identification and misspecification in cross-sectional analysis," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 8(3), pages 267-277, September.
- Jostein Grytten & Fredrik Carlsen & Irene Skau, 2001. "The income effect and supplier induced demand. Evidence from primary physician services in Norway," Applied Economics, Taylor & Francis Journals, vol. 33(11), pages 1455-1467.
- Grytten, Jostein & Carlsen, Fredrik & Sorensen, Rune, 1995. "Supplier inducement in a public health care system," Journal of Health Economics, Elsevier, vol. 14(2), pages 207-229, June.
- Eric Delattre & Brigitte Dormont, 2003. "Fixed fees and physician-induced demand: A panel data study on French physicians," Health Economics, John Wiley & Sons, Ltd., vol. 12(9), pages 741-754.
When requesting a correction, please mention this item's handle: RePEc:eee:hepoli:v:91:y:2009:i:2:p:121-134. 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: (Shamier, Wendy)or ()
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.