Is physician cost-sharing an alternative to patient cost-sharing?

This paper examines whether financial incentives for general practitioners (GPs) can effectively replace patient cost-sharing within a gatekeeper healthcare system in which the GP regulates access to specialist care. We estimate the effects of incentives provided to GPs by exploiting a field experiment in which treated GPs received a share of the cost savings they achieved. There was also a set of control practices. The patient population includes about 26,000 individuals and is largely representative of the overall population in the Netherlands. We estimate the effects of incentives for patients provided by a deductible using a simulated instrumental variables approach. For both sets of analyses, we use the same measures of healthcare costs, the same time period, and the same population of patients. Our findings show that the incentives provided to GPs reduce costs by 4.3 percent, mainly by decreasing less-urgent specialist care. A small patient deductible of 375 euros per year reduces costs by 27.8 percent in each month in which patients still have to pay out-of-pocket and 10.4 percent at the annual level, impacting all types of care. In contrast, physicians discriminate by type and priority of care. We do not find clear patterns for the interaction of incentives provided to GPs and patients. Our results suggest that GP incentives may complement but not fully replace patient deductibles in managing healthcare costs effectively.