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Competition and Physician Behaviour: Does the Competitive Environment Affect the Propensity to Issue Sickness Certificates?

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  • Kurt R. Brekke
  • Tor Helge Holmås
  • Karin Monstad
  • Odd Rune Straume

Abstract

Competition among physicians is widespread, but compelling empirical evidence on the impact on service provision is limited, mainly due to lack of exogenous variation in the degree of competition. In this paper we exploit that many GPs, in addition to own practice, work in local emergency centres, where the matching of patients to GPs is random. This allows us to observe the same GP in two different competitive environments; with competition (own practice) and without competition (emergency centre). Using rich administrative patient- level data from Norway for 2006-14, which allow us to estimate high-dimensional fixed-effect models to control for time-invariant patient and GP heterogeneity, we find that GPs with a fee-for-service (fixed-salary) contract are 12 (7.5) percentage points more likely to certify sick leave at own practice than at the emergency centre. Thus, competition has a positive impact on GPs’ sick listing that is strongly reinforced by financial incentives.

Suggested Citation

  • Kurt R. Brekke & Tor Helge Holmås & Karin Monstad & Odd Rune Straume, 2017. "Competition and Physician Behaviour: Does the Competitive Environment Affect the Propensity to Issue Sickness Certificates?," CESifo Working Paper Series 6672, CESifo.
  • Handle: RePEc:ces:ceswps:_6672
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    Cited by:

    1. Jeannette Brosig‐Koch & Burkhard Hehenkamp & Johanna Kokot, 2023. "Who benefits from quality competition in health care? A theory and a laboratory experiment on the relevance of patient characteristics," Health Economics, John Wiley & Sons, Ltd., vol. 32(8), pages 1785-1817, August.
    2. Gravelle, Hugh & Liu, Dan & Propper, Carol & Santos, Rita, 2019. "Spatial competition and quality: Evidence from the English family doctor market," Journal of Health Economics, Elsevier, vol. 68(C).
    3. Godager , Geir & Scott, Anthony, 2023. "Physician Behavior and Health Outcomes," HERO Online Working Paper Series 2023:3, University of Oslo, Health Economics Research Programme.
    4. Francisco Gomez Martinez & Sander Onderstal & Maarten Pieter Schinkel, 2019. "Can Collusion Promote Corporate Social Responsibility? Evidence from the Lab," Tinbergen Institute Discussion Papers 19-034/VII, Tinbergen Institute, revised 12 Nov 2019.
    5. Nguyen-Ones, Mai & Steen, Frode, 2018. "Measuring Market Power in Gasoline Retailing: A Market- or Station Phenomenon?," Discussion Paper Series in Economics 6/2018, Norwegian School of Economics, Department of Economics.
    6. Beckert, Walter, 2018. "Choice in the presence of experts: The role of general practitioners in patients’ hospital choice," Journal of Health Economics, Elsevier, vol. 60(C), pages 98-117.
    7. Jens Dietrichson & Lina Maria Ellegård & Gustav Kjellsson, 2020. "Patient choice, entry, and the quality of primary care: Evidence from Swedish reforms," Health Economics, John Wiley & Sons, Ltd., vol. 29(6), pages 716-730, June.
    8. Morreel, Stefan & Homburg, Ines & Philips, Hilde & De Graeve, Diana & Monsieurs, Koenraad G. & Meysman, Jasmine & Lefevere, Eva & Verhoeven, Veronique, 2022. "Cost effects of nurse led triage at an emergency department with the advice to consult the adjacent general practice cooperative for low-risk patients, a cluster randomised trial," Health Policy, Elsevier, vol. 126(10), pages 980-987.
    9. Peter Rønø Thingholm, 2023. "Provider Spill-Overs in Opioid Prescription Leniency and Patient – Labor Market Outcomes," Economics Working Papers 2023-05, Department of Economics and Business Economics, Aarhus University.

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    More about this item

    Keywords

    physicians; competition; sickness certification;
    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
    • L13 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - Oligopoly and Other Imperfect Markets

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