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Four Empirical Essays on the Market for General Practitioners' Services

Listed author(s):
  • Godager, Geir


    (Institute of Health Management and Health Economics)

This dissertation consists of empirical essays within the subject of health economics. There are four essays in applied micro-econometrics and, as data in Essays 2 and 4 have a panel format, econometric methods for panel data are applied. Tobit-type models for limited dependent variables are applied in Essays 3 and 4, Nested logit models for choice of general practitioner (GP) are applied in Essay 1 and in Essay 2 modeling and estimation procedures involving latent structural variables are applied. The market for GPs' services is the recurrent theme, and a common feature of the empirical modeling and estimation conducted in the essays of this dissertation is that latent variables play an important role. There are several motivations for studying the market for GPs. GPs play a key role and constitute the cornerstone of the health care sector in Norway and other countries with a national health service. The GP is often a patient's first encounter with the health care sector. In Norway the GP also acts as a “gatekeeper”, and a referral from the GP is necessary in order to receive specialized care. Further, decisions made by GPs have a large impact on public spending such as sick-leave benefits and drug reimbursements. Due to this pivotal role of general practice, any research providing policy guidance for the sector will potentially have noticeable welfare effects. Studying this market may also provide advances in terms of enhanced understanding of economic behavior in general, and within the discipline of health economics in particular. Arrow's (1963) article describing various imperfections in the market for medical care is often considered to mark the founding of health economics (Culyer and Newhouse, 2000). Many of the peculiarities Arrow describes are, indeed, present in the market for GPs' services. Asymmetric information limits consumer sovereignty and creates challenges for designing appropriate contracts and payment mechanisms. Quality of services is diffcult to observe and quantify, and optimal consumption of health care services is diffcult to achieve. While the general research questions in health economics are relevant in the specific context of general practice, the conditions for knowledge accumulation seem favorable as well. The availability of detailed and disaggregated panel data enables identification and quantification of the mechanisms in focus by applying a large variety of modeling and estimation methods. In addition, one may argue that economic theory is well suited to model individual behavior and that assumptions of rational decision makers are more realistic when describing individuals such as GPs than when describing institutions such as hospitals. Fuchs (2000) describes two related missions of health economists: providing valuable input into health policy and enhancing understanding of economic behavior. Both missions motivate research on the market for GPs. Essays 1 and 2 in this dissertation focus mainly on factors influencing the patients' or consumers' decision to seek the services of a particular GP, while Essays 3 and 4 focus on factors influencing the GP's supply decision. The rest of the text proceeds as follows: The next subsection provides a brief introduction to the topic of this dissertation. Summaries of the four essays are given in subsection 1.3. Policy implications of the findings are presented in subsection 1.4. Limitations and ideas for future research are discussed in subsection 1.5. Complete versions of Essays 1-4 follow in sections 2-5.

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Paper provided by Oslo University, Health Economics Research Programme in its series HERO On line Working Paper Series with number 2009:7.

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Length: 141 pages
Date of creation: 28 Sep 2009
Handle: RePEc:hhs:oslohe:2009_007
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
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References listed on IDEAS
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  1. 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.
  2. Melenberg, Bertrand & van Soest, Arthur, 1996. "Parametric and Semi-parametric Modelling of Vacation Expenditures," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 11(1), pages 59-76, Jan.-Feb..
  3. Yip, Winnie C., 1998. "Physician response to Medicare fee reductions: changes in the volume of coronary artery bypass graft (CABG) surgeries in the Medicare and private sectors," Journal of Health Economics, Elsevier, vol. 17(6), pages 675-699, December.
  4. Pedro Pita Barros & Pau Olivella, 2005. "Waiting Lists and Patient Selection," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 14(3), pages 623-646, September.
  5. Iversen, Tor, 1997. "The effect of a private sector on the waiting time in a national health service," Journal of Health Economics, Elsevier, vol. 16(4), pages 381-396, August.
  6. Godager, Geir & Lurås, Hilde, 2009. "I skyggen av Fastlegeordningen: Hvordan har det gått med det offentlige legearbeidet?," HERO On line Working Paper Series 2005:6, Oslo University, Health Economics Research Programme.
  7. Cragg, John G, 1971. "Some Statistical Models for Limited Dependent Variables with Application to the Demand for Durable Goods," Econometrica, Econometric Society, vol. 39(5), pages 829-844, September.
  8. Mroz, Thomas A, 1987. "The Sensitivity of an Empirical Model of Married Women's Hours of Work to Economic and Statistical Assumptions," Econometrica, Econometric Society, vol. 55(4), pages 765-799, July.
  9. Eggleston, Karen & Bir, Anupa, 2006. "Physician dual practice," Health Policy, Elsevier, vol. 78(2-3), pages 157-166, October.
  10. Badi H. Baltagi & Espen Bratberg & Tor Helge Holmås, 2003. "A Panel Data Study of Physicians’ Labor Supply: The Case of Norway," CESifo Working Paper Series 895, CESifo Group Munich.
  11. Iversen, Tor, 2004. "The effects of a patient shortage on general practitioners' future income and list of patients," Journal of Health Economics, Elsevier, vol. 23(4), pages 673-694, July.
  12. Culler, Steven D. & Bazzoli, Gloria J., 1985. "The moonlighting decisions of resident physicians," Journal of Health Economics, Elsevier, vol. 4(3), pages 283-292, September.
  13. Showalter, Mark H. & Thurston, Norman K., 1997. "Taxes and labor supply of high-income physicians," Journal of Public Economics, Elsevier, vol. 66(1), pages 73-97, October.
  14. Kathryn M. Langwell, 1982. "Factors Affecting the Incomes of Men and Women Physicians: Further Explorations," Journal of Human Resources, University of Wisconsin Press, vol. 17(2), pages 261-275.
  15. Amemiya, Takeshi, 1984. "Tobit models: A survey," Journal of Econometrics, Elsevier, vol. 24(1-2), pages 3-61.
  16. Kristiansen, Ivar Sønbø & Mooney, Gavin, 1993. "The general practitioner's use of time: Is it influenced by the remuneration system?," Social Science & Medicine, Elsevier, vol. 37(3), pages 393-399, August.
  17. Shishko, Robert & Rostker, Bernard, 1976. "The Economics of Multiple Job Holding," American Economic Review, American Economic Association, vol. 66(3), pages 298-308, June.
  18. Iversen, Tor & Lurås, Hilde, 2009. "The importance of micro-data for revaealing income motivated behaviour among GPs," HERO On line Working Paper Series 1999:3, Oslo University, Health Economics Research Programme.
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