IDEAS home Printed from
MyIDEAS: Log in (now much improved!) to save this paper

The effect of patient shortage on general practitioners’ future income and list of patients

Listed author(s):
  • Iversen, Tor


    (Institute of Health Management and Health Economics)

The literature on supplier inducement suffers from inability to distinguish the effect of better access from the effect of patient shortage. Data from the Norwegian capitation trial in general practice give us an opportunity to make this distinction and hence, study whether service provision by physicians is income motivated. In the capitation trial each general practitioner (GP) has a personal list of patients. The payment system is a mix of a capitation fee and a fee for service. The data set has information on patient shortage, i.e. a positive difference between a GP’s preferred and actual list size, at the individual practice level. From a model of a GP’s optimal choice we derive the optimal practice profile contingent on whether a GP experiences a shortage of patients or not. To what extent GPs, who experience a shortage, will undertake measures to attract patients or embark on a service intensive practice style, depends on the costs of the various measures relative to their expected benefit. The model classifies GPs into five types. In the empirical analysis a panel of GPs is followed for five years. Hence, short-term effects due to transition to a new system should have been overcome. We show that even in the longer run, GPs who experience a shortage of patients have a higher income per listed person than their unrationed colleagues. This result is robust with regard to correction for potential selection bias based on observable and unobservable characteristics. We do not find any significant difference in income per listed person dependent on whether a rationed GP obtains an increase in the number of patients or not. A policy implication is that patient shortage is costly to the insurer because of income motivated behavior of unknown benefit to the patient.

If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.

File URL:
Download Restriction: no

Paper provided by Oslo University, Health Economics Research Programme in its series HERO On line Working Paper Series with number 2003:1.

in new window

Length: 30 pages
Date of creation: 21 Jun 2009
Handle: RePEc:hhs:oslohe:2003_001
Contact details of provider: Postal:
HERO / Institute of Health Management and Health Economics P.O. Box 1089 Blindern, N-0317 Oslo, Norway

Phone: 2307 5309
Fax: 2307 5310
Web page:

More information through EDIRC

No references listed on IDEAS
You can help add them by filling out this form.

This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.

When requesting a correction, please mention this item's handle: RePEc:hhs:oslohe:2003_001. See general information about how to correct material in RePEc.

For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Anbjørg Kolaas)

If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

If references are entirely missing, you can add them using this form.

If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.

If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.

Please note that corrections may take a couple of weeks to filter through the various RePEc services.

This information is provided to you by IDEAS at the Research Division of the Federal Reserve Bank of St. Louis using RePEc data.