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Competition and physician behaviour: Does the competitive environment the propensity to issue sickness certificates?

Listed author(s):
  • Brekke, Kurt R.

    ()

    (Dept. of Economics, Norwegian School of Economics and Business Administration)

  • Holmås, Tor Helge

    ()

    (Uni Research Rokkan Centre)

  • Monstad, Karin

    ()

    (Uni Research Rokkan Centre)

  • Straume, Odd Rune

    ()

    (University of Minho)

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 fi…xed-effect models to control for time-invariant patient and GP heterogeneity, we …nd that GPs with a fee-for-service (…fixed salary) contract are 11 (8) 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 reinforced by …nancial incentives.

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File URL: https://brage.bibsys.no/xmlui/bitstream/handle/11250/2434279/DP%2003.pdf?sequence=1&isAllowed=y
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Paper provided by Department of Economics, Norwegian School of Economics in its series Discussion Paper Series in Economics with number 3/2017.

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Length: 38 pages
Date of creation: 12 Feb 2017
Handle: RePEc:hhs:nhheco:2017_003
Contact details of provider: Postal:
NHH, Department of Economics, Helleveien 30, N-5045 Bergen, Norway

Phone: +47 55 959 277
Fax: 5595 9100
Web page: http://www.nhh.no/sam/
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  10. Kurt R. Brekke & Roberto Cellini & Luigi Siciliani & Odd Rune Straume, 2012. "Competition in Regulated Markets with Sluggish Beliefs about Quality," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 21(1), pages 131-178, 03.
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  14. 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.
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  17. Devlin, Rose Anne & Sarma, Sisira, 2008. "Do physician remuneration schemes matter? The case of Canadian family physicians," Journal of Health Economics, Elsevier, vol. 27(5), pages 1168-1181, September.
  18. Dusheiko, Mark & Gravelle, Hugh & Jacobs, Rowena & Smith, Peter, 2006. "The effect of financial incentives on gatekeeping doctors: Evidence from a natural experiment," Journal of Health Economics, Elsevier, vol. 25(3), pages 449-478, May.
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