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Competition, Gatekeeping, and Health Care Access

  • Godager, Geir

    ()

    (Department of Health Management and Health Economics)

  • Iversen, Tor

    ()

    (Department of Health Management and Health Economics)

  • Albert Ma, Ching-to

    (Department of Economics, Boston University and University of Oslo)

We study the impact of competition on primary care physicians’specialty referrals. Our data come from a Norwegian survey in 2008-9 and Statistics Norway. From the data we construct three measures of competition the number of open primary physician practices with and without population adjustment, and the Her…ndahl-Hirschman Index. We build a theoretical model, and derive two opposing e¤ects of competition on gatekeeping physicians’ specialty referrals. The empirical results suggest that competition has negligible or small positive e¤ects on referrals. Our results do not support the policy claim that increasing the number of primary care physicians reduces secondary care.

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File URL: https://www.med.uio.no/helsam/forskning/nettverk/hero/publikasjoner/skriftserie/2012/hero2012-2.pdf
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Paper provided by Oslo University, Health Economics Research Programme in its series HERO On line Working Paper Series with number 2012:2.

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Length: 30 pages
Date of creation: 01 Aug 2012
Date of revision:
Handle: RePEc:hhs:oslohe:2012_002
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: http://www.hero.uio.no/eng.html
Email:


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  1. Wright, David Bradley & Ricketts III, Thomas C., 2010. "The road to efficiency? Re-examining the impact of the primary care physician workforce on health care utilization rates," Social Science & Medicine, Elsevier, vol. 70(12), pages 2006-2010, June.
  2. Ching-to Albert MA & Tor Iversen, 2010. "Market conditions and general practitioners’ referrals," Boston University - Department of Economics - Working Papers Series WP2010-023, Boston University - Department of Economics.
  3. Pau Olivella Cunill & Pedro Pita Barros, 2000. "Waiting Lists and Patient Selection," Econometric Society World Congress 2000 Contributed Papers 0283, Econometric Society.
  4. Chen, Xing & Godager, Geir, 2011. "Development of competition indicators in the Norwegian general practice: Constructing a postal code-specific Herfindahl-Hirschman index applying STATA software," HERO On line Working Paper Series 2011:1, Oslo University, Health Economics Research Programme.
  5. Dranove, David & Wehner, Paul, 1994. "Physician-induced demand for childbirths," Journal of Health Economics, Elsevier, vol. 13(1), pages 61-73, March.
  6. Atella, Vincenzo & Deb, Partha, 2008. "Are primary care physicians, public and private sector specialists substitutes or complements? Evidence from a simultaneous equations model for count data," Journal of Health Economics, Elsevier, vol. 27(3), pages 770-785, May.
  7. Tor Iversen & Gry Stine Kopperud, 2005. "Regulation versus practice - the impact of accessibility on the use of specialist health care in Norway," Health Economics, John Wiley & Sons, Ltd., vol. 14(12), pages 1231-1238.
  8. Iversen, Tor & Lurås, Hilde, 2011. "Patient switching in general practice," Journal of Health Economics, Elsevier, vol. 30(5), pages 894-903.
  9. Mark V. Pauly, 2004. "Competition in Medical Services and the Quality of Care: Concepts and History," International Journal of Health Care Finance and Economics, Springer, vol. 4(2), pages 113-130, 06.
  10. Katherine Baicker & Amitabh Chandra, 2004. "The Productivity of Physician Specialization: Evidence from the Medicare Program," American Economic Review, American Economic Association, vol. 94(2), pages 357-361, May.
  11. Marie Allard & Izabela Jelovac & Pierre-Thomas Léger, 2011. "Treatment and referral decisions under different physician payment mechanisms," Post-Print halshs-00650933, HAL.
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