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Competition, Gatekeeping, and Health Care Access

Author

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  • 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)

Abstract

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.

Suggested Citation

  • Godager, Geir & Iversen, Tor & Albert Ma, Ching-to, 2012. "Competition, Gatekeeping, and Health Care Access," HERO Online Working Paper Series 2012:2, University of Oslo, Health Economics Research Programme.
    • Handle: RePEc:hhs:oslohe:2012_002
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    Cited by:

    1. Jeannette Brosig‐Koch & Burkhard Hehenkamp & Johanna Kokot, 2023. "Who benefits from quality competition in health care? A theory and a laboratory experiment on the relevance of patient characteristics," Health Economics, John Wiley & Sons, Ltd., vol. 32(8), pages 1785-1817, August.
    2. Brekke, Kurt R. & Holmås, Tor Helge & Monstad, Karin & Straume, Odd Rune, 2019. "Competition and physician behaviour: Does the competitive environment affect the propensity to issue sickness certificates?," Journal of Health Economics, Elsevier, vol. 66(C), pages 117-135.
    3. Markussen, Simen & Røed, Knut, 2017. "The market for paid sick leave," Journal of Health Economics, Elsevier, vol. 55(C), pages 244-261.
    4. Schaumans, C.B.C., 2014. "Prescribing Behavior of General Practitioners : Competition Matters!," Other publications TiSEM 6d0d2ee7-fe03-41c3-89bc-8, Tilburg University, School of Economics and Management.
    5. Griebenow, Malte & Kifmann, Mathias, 2021. "Diagnostics and treatment: On the division of labor between primary care physicians and specialists," hche Research Papers 25, University of Hamburg, Hamburg Center for Health Economics (hche).
    6. Godager, Geir & Hennig-Schmidt, Heike & Li, Jing Jing & Wang, Jian & Yang, Fan, 2021. "Does gender affect medical decisions? Results from a behavioral experiment with physicians and medical students," HERO Online Working Paper Series 2021:1, University of Oslo, Health Economics Research Programme.
    7. Anthony Scott & Peter Sivey, 2022. "Motivation and competition in health care," Health Economics, John Wiley & Sons, Ltd., vol. 31(8), pages 1695-1712, August.
    8. Ge Ge & Geir Godager & Jian Wang, 2022. "Exploring physician agency under demand‐side cost sharing—An experimental approach," Health Economics, John Wiley & Sons, Ltd., vol. 31(6), pages 1202-1227, June.
    9. Brüll, Eduard & Rostam-Afschar, Davud & Schlenker, Oliver, 2024. "Cut off from new competition: Threat of entry and health care quality," Working Papers 41, University of Konstanz, Cluster of Excellence "The Politics of Inequality. Perceptions, Participation and Policies".
    10. Jeannette Brosig‐Koch & Burkhard Hehenkamp & Johanna Kokot, 2017. "The effects of competition on medical service provision," Health Economics, John Wiley & Sons, Ltd., vol. 26(S3), pages 6-20, December.
    11. Schaumans, Catherine, 2015. "Prescribing behavior of General Practitioners: Competition matters," Health Policy, Elsevier, vol. 119(4), pages 456-463.
    12. Sisira Sarma & Nirav Mehta & Rose Anne Devlin & Koffi Ahoto Kpelitse & Lihua Li, 2018. "Family physician remuneration schemes and specialist referrals: Quasi‐experimental evidence from Ontario, Canada," Health Economics, John Wiley & Sons, Ltd., vol. 27(10), pages 1533-1549, October.
    13. Waibel, Christian & Wiesen, Daniel, 2016. "Kickbacks, referrals and efficiency in health care markets: Experimental evidence," HERO Online Working Paper Series 2016:8, University of Oslo, Health Economics Research Programme.
    14. Kaarboe, Oddvar & Siciliani, Luigi, 2023. "Contracts for primary and secondary care physicians and equity-efficiency trade-offs," Journal of Health Economics, Elsevier, vol. 87(C).
    15. Abe Dunn & Adam Hale Shapiro, 2018. "Physician Competition and the Provision of Care: Evidence from Heart Attacks," American Journal of Health Economics, MIT Press, vol. 4(2), pages 226-261, Spring.
    16. Godager, Geir & Hennig-Schmidt, Heike & Iversen, Tor, 2016. "Does performance disclosure influence physicians’ medical decisions? An experimental study," Journal of Economic Behavior & Organization, Elsevier, vol. 131(PB), pages 36-46.
    17. Godager , Geir & Scott, Anthony, 2023. "Physician Behavior and Health Outcomes," HERO Online Working Paper Series 2023:3, University of Oslo, Health Economics Research Programme.
    18. Sarah M. Hofmann & Andrea M. Muehlenweg, 2016. "Gatekeeping in German Primary Health Care - Impacts on Coordination of Care, Quality Indicators and Ambulatory Costs," CINCH Working Paper Series 1605, Universitaet Duisburg-Essen, Competent in Competition and Health, revised Sep 2016.
    19. Jianpei Wen & Hanyu Jiang & Jie Song, 2019. "A Stochastic Queueing Model for Capacity Allocation in the Hierarchical Healthcare Delivery System," Asia-Pacific Journal of Operational Research (APJOR), World Scientific Publishing Co. Pte. Ltd., vol. 36(01), pages 1-24, February.
    20. Tor Iversen & Anastasia Mokienko, 2016. "Supplementing gatekeeping with a revenue scheme for secondary care providers," International Journal of Health Economics and Management, Springer, vol. 16(3), pages 247-267, September.
    21. Waibel, Christian & Wiesen, Daniel, 2021. "An experiment on referrals in health care," European Economic Review, Elsevier, vol. 131(C).
    22. Newman, Christopher L. & Howlett, Elizabeth & Burton, Scot, 2014. "Shopper Response to Front-of-Package Nutrition Labeling Programs: Potential Consumer and Retail Store Benefits," Journal of Retailing, Elsevier, vol. 90(1), pages 13-26.
    23. Schaumans, C.B.C., 2014. "Prescribing Behavior of General Practitioners : Competition Matters!," Other publications TiSEM c8445d1f-66f8-4238-835e-d, Tilburg University, School of Economics and Management.

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    More about this item

    Keywords

    primary; care; physicians;
    All these keywords.

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health

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