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How French general practitioners respond to declining medical density: a study on prescription practices, with an insight into opioids use

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  • Julien Silhol

    (Institut National de la Statistique et des Etudes Economiques (Insee)
    Aix-Marseille University, CNRS, EHESS, Centrale Marseille, AMSE)

  • Bruno Ventelou

    (Aix-Marseille University, CNRS, EHESS, Centrale Marseille, AMSE)

  • Anna Zaytseva

    (Aix-Marseille University, CNRS, EHESS, Centrale Marseille, AMSE)

Abstract

Disparities in physicians' geographical distribution lead to highly unequal access to healthcare, which may impact quality of care in both high and low-income countries. This paper uses a 2013–2014 nationally representative survey of French general practitioners (GPs) matched with corresponding administrative data to analyze the effects of practicing in an area with weaker medical density. To avoid the endogeneity issue on physicians' choice of the location, we enriched our variable of interest, practicing in a relatively underserved area, with considering changes in medical density between 2007 and 2013, thus isolating GPs who only recently experienced a density decline (identifying assumption). We find that GPs practicing in underserved areas do shorter consultations and tend to substitute time-consuming procedures with alternatives requiring fewer human resources, especially for pain management. Results are robust to considering only GPs newly exposed to low medical density. Findings suggest a significant impact of supply-side shortages on the mix of healthcare services used to treat patients, and point to a plausible increased use of painkillers, opioids in particular.

Suggested Citation

  • Julien Silhol & Bruno Ventelou & Anna Zaytseva, 2020. "How French general practitioners respond to declining medical density: a study on prescription practices, with an insight into opioids use," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(9), pages 1391-1398, December.
    • Handle: RePEc:spr:eujhec:v:21:y:2020:i:9:d:10.1007_s10198-020-01222-8
    DOI: 10.1007/s10198-020-01222-8
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    1. Audrey Michel-Lepage & Bruno Ventelou, 2016. "The true impact of the French pay-for-performance program on physicians’ benzodiazepines prescription behavior," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(6), pages 723-732, July.
    2. 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, November.
    3. 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.
    4. Daniël van Hassel & Robert Verheij & Ronald Batenburg, 2019. "Assessing the variation in workload among general practitioners in urban and rural areas: An analysis based on SMS time sampling data," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(1), pages 474-486, January.
    5. 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.
    6. Kann, Inger Cathrine & Biørn, Erik & Lurås, Hilde, 2010. "Competition in general practice: Prescriptions to the elderly in a list patient system," Journal of Health Economics, Elsevier, vol. 29(5), pages 751-764, September.
    7. Ruhm, Christopher J., 2019. "Drivers of the fatal drug epidemic," Journal of Health Economics, Elsevier, vol. 64(C), pages 25-42.
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    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 9th November 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-11-09 12:00:00

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    Cited by:

    1. Cassou, Matthieu & Mousquès, Julien & Franc, Carine, 2023. "General Practitioners activity patterns: the medium-term impacts of Primary Care Teams in France," Health Policy, Elsevier, vol. 136(C).
    2. Ilaria Natali & Mathias Dewatripont & Victor Ginsburgh & Michel Goldman & Patrick Legros, 2023. "Prescription opioids and economic hardship in France," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(9), pages 1473-1504, December.
    3. Anna Zaytseva & Pierre Verger & Bruno Ventelou, 2021. "United, we can be stronger! French integrated general practitioners had better chronic care follow-up during lockdown," AMSE Working Papers 2132, Aix-Marseille School of Economics, France.
    4. Anna Zaytseva & Pierre Verger & Bruno Ventelou, 2022. "United, can we be stronger? Did French general practitioners in multi-professional groups provide more chronic care follow-up during lockdown?," Post-Print hal-03660015, HAL.

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    More about this item

    Keywords

    Health workforce; Medically underserved area; General practitioners; Prescriptions; Opioids; France;
    All these keywords.

    JEL classification:

    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • C31 - Mathematical and Quantitative Methods - - Multiple or Simultaneous Equation Models; Multiple Variables - - - Cross-Sectional Models; Spatial Models; Treatment Effect Models; Quantile Regressions; Social Interaction Models

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