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The Gate is Open: Primary Care Physicians as Social Security Gatekeepers

Author

Listed:
  • Carlsen, Benedicte

    (The Rokkan Centre, University of Bergen)

  • Nyborg, Karine

    () (Dept. of Economics, University of Oslo)

Abstract

Primary care physicians have two roles: the healer and the gatekeeper. We show that, due to information asymmetries, they cannot be expected to fulfill the latter role. Better gatekeepers will be poorer healers; hence all patients, both truly sick and shirkers, will strictly prefer physicians who give priority to healing. The choice between work and sick leave thus lies, essentially, with the patient. Interviews with Norwegian primary care physicians confirm this: Our interviewees report that shorter sick leaves are granted at request, while longer sick leaves are normally granted if the patient still prefer so after discussions with the physician.

Suggested Citation

  • Carlsen, Benedicte & Nyborg, Karine, 2009. "The Gate is Open: Primary Care Physicians as Social Security Gatekeepers," Memorandum 07/2009, Oslo University, Department of Economics.
  • Handle: RePEc:hhs:osloec:2009_007
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    File URL: https://www.sv.uio.no/econ/english/research/unpublished-works/working-papers/pdf-files/2009/Memo-07-2009.pdf
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    References listed on IDEAS

    as
    1. Chalkley, Martin & Malcomson, James M., 1998. "Contracting for health services when patient demand does not reflect quality," Journal of Health Economics, Elsevier, vol. 17(1), pages 1-19, January.
    2. Ayres, Philip J., 1996. "Rationing health care: Views from general practice," Social Science & Medicine, Elsevier, vol. 42(7), pages 1021-1025, April.
    3. Ose, Solveig Osborg, 2005. "Working conditions, compensation and absenteeism," Journal of Health Economics, Elsevier, vol. 24(1), pages 161-188, January.
    4. Rochaix, Lise, 1989. "Information asymmetry and search in the market for physicians' services," Journal of Health Economics, Elsevier, vol. 8(1), pages 53-84, March.
    5. De Jaegher, Kris & Jegers, Marc, 2000. "A model of physician behaviour with demand inducement," Journal of Health Economics, Elsevier, vol. 19(2), pages 231-258, March.
    6. Dranove, David, 1988. "Demand Inducement and the Physician/Patient Relationship," Economic Inquiry, Western Economic Association International, vol. 26(2), pages 281-298, April.
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    Cited by:

    1. repec:eee:jhecon:v:55:y:2017:i:c:p:244-261 is not listed on IDEAS
    2. Torsvik, Gaute & Vaage, Kjell, 2014. "Gatekeeping versus monitoring: Evidence from a case with extended self-reporting of sickness absence," Working Papers in Economics 08/14, University of Bergen, Department of Economics.
    3. 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.
    4. Harald Dale-Olsen, 2014. "Sickness Absence, Sick Leave Pay, and Pay Schemes," LABOUR, CEIS, vol. 28(1), pages 40-63, March.
    5. Bryson, Alex & Dale-Olsen, Harald, 2017. "Does Sick Pay Affect Workplace Absence?," IZA Discussion Papers 11222, Institute for the Study of Labor (IZA).
    6. Markussen, Simen & Røed, Knut, 2017. "The market for paid sick leave," Journal of Health Economics, Elsevier, vol. 55(C), pages 244-261.
    7. Markussen, Simen, 2009. "Closing the Gates? Evidence from a Natural Experiment on Physicians' Sickness Certification," Memorandum 19/2009, Oslo University, Department of Economics.
    8. Markussen, Simen, 2009. "The Effects of Sick-Leaves on Earnings," Memorandum 20/2009, Oslo University, Department of Economics.
    9. Baert, Stijn & van der Klaauw, Bas & van Lomwel, Gijsbert, 2016. "The Effectiveness of Medical and Vocational Interventions for Reducing Sick Leave of Self-Employed Workers," IZA Discussion Papers 9692, Institute for the Study of Labor (IZA).

    More about this item

    Keywords

    Sicklisting; subjective diagnoses; asymmetric information; focus group interviews.;

    JEL classification:

    • D11 - Microeconomics - - Household Behavior - - - Consumer Economics: Theory
    • D21 - Microeconomics - - Production and Organizations - - - Firm Behavior: Theory
    • H42 - Public Economics - - Publicly Provided Goods - - - Publicly Provided Private Goods
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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