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The "gatekeeping" role of general practitioners. Does patients' information matter ?

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  • GONZALEZ, Paula

Abstract

We deal with a principal-agent model in which the health authority acts as a principal for both a patient and a General Practitioner (GP). In this framework, we study the role of GPs as filters for secondary care, emphasizing the implications that patients' information may have for health authorities. We derive the GP's payment contract that induces him to perform diagnosis and follow its recommendation, as well as the level of copayments that provide patients with incentives to select the appropriate medical provider. We show that when patients can freely choose their provider, the quality of their information has contradictory effects. The higher this quality is, the lower the expected losses the patient bears. A higher quality, however, worsens the GP's agency problem, as GPs have more incentives to use patients' information as a substitute for their own diagnosis. We also analyze the role of patients' pressure for referral on the choice of the optimal system to access secondary care.

Suggested Citation

  • GONZALEZ, Paula, 2003. "The "gatekeeping" role of general practitioners. Does patients' information matter ?," LIDAM Discussion Papers CORE 2003089, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
    • Handle: RePEc:cor:louvco:2003089
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    1. Martin, D.P. & Diehr, P. & Price, K.F. & Richardson, W.C., 1989. "Effect of a gatekeeper plan on health services use and charges: A randomized trial," American Journal of Public Health, American Public Health Association, vol. 79(12), pages 1628-1632.
    2. 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.
    3. Paula González, 2004. "Should physicians' dual practice be limited? An incentive approach," Health Economics, John Wiley & Sons, Ltd., vol. 13(6), pages 505-524, June.
    4. Marinoso, Begona Garcia & Jelovac, Izabela, 2003. "GPs' payment contracts and their referral practice," Journal of Health Economics, Elsevier, vol. 22(4), pages 617-635, July.
    5. Brekke, Kurt R. & Nuscheler, Robert & Straume, Odd Rune, 2007. "Gatekeeping in health care," Journal of Health Economics, Elsevier, vol. 26(1), pages 149-170, January.
    6. Scott, Anthony, 2000. "Economics of general practice," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 22, pages 1175-1200, Elsevier.
    7. James M. Malcomson, 2004. "Health Service Gatekeepers," RAND Journal of Economics, The RAND Corporation, vol. 35(2), pages 401-421, Summer.
    8. Erik Schokkaert & Carine Van de Voorde, 2005. "Health care reform in Belgium," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 25-39, September.
    9. Croxson, B. & Propper, C. & Perkins, A., 2001. "Do doctors respond to financial incentives? UK family doctors and the GP fundholder scheme," Journal of Public Economics, Elsevier, vol. 79(2), pages 375-398, February.
    10. Izabela Jelovac, 2001. "Physicians' payment contracts, treatment decisions and diagnosis accuracy," Health Economics, John Wiley & Sons, Ltd., vol. 10(1), pages 9-25, January.
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    Cited by:

    1. Brekke, Kurt R. & Nuscheler, Robert & Straume, Odd Rune, 2007. "Gatekeeping in health care," Journal of Health Economics, Elsevier, vol. 26(1), pages 149-170, January.
    2. Tor Iversen & Ching-to Ma, 2011. "Market conditions and general practitioners’ referrals," International Journal of Health Economics and Management, Springer, vol. 11(4), pages 245-265, December.

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    More about this item

    Keywords

    general practice; incentives; patients’ beliefs; patients’ pressure; referrals;
    All these keywords.

    JEL classification:

    • D82 - Microeconomics - - Information, Knowledge, and Uncertainty - - - Asymmetric and Private Information; Mechanism Design
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • L51 - Industrial Organization - - Regulation and Industrial Policy - - - Economics of Regulation

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