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Competition, Gatekeeping, and Health Care Access

Author

Listed:
  • 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 On line Working Paper Series 2012:2, Oslo University, Health Economics Research Programme.
  • Handle: RePEc:hhs:oslohe:2012_002
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    References listed on IDEAS

    as
    1. Gaynor, Martin & Town, Robert J., 2011. "Competition in Health Care Markets," Handbook of Health Economics, Elsevier.
    2. 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.
    3. Fang, Hai & Rizzo, John A., 2009. "Competition and physician-enabled demand: The role of managed care," Journal of Economic Behavior & Organization, Elsevier, vol. 72(1), pages 463-474, October.
    4. 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.
    5. 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.
    6. Lafkiri, Khalid, 2010. "Municipality level accessibility to specialized health care in Norway," HERO On line Working Paper Series 2010:7, Oslo University, Health Economics Research Programme.
    7. Gary Biglaiser & Ching-to Albert Ma, 2007. "Moonlighting: public service and private practice," RAND Journal of Economics, RAND Corporation, vol. 38(4), pages 1113-1133, December.
    8. Iversen, Tor & Lurås, Hilde, 2011. "Patient switching in general practice," Journal of Health Economics, Elsevier, vol. 30(5), pages 894-903.
    9. Brekke, Kurt R. & Nuscheler, Robert & Straume, Odd Rune, 2007. "Gatekeeping in health care," Journal of Health Economics, Elsevier, vol. 26(1), pages 149-170, January.
    10. Tor Iversen & Ching-to Ma, 2011. "Market conditions and general practitioners’ referrals," International Journal of Health Economics and Management, Springer, vol. 11(4), pages 245-265, December.
    11. Marinoso, Begona Garcia & Jelovac, Izabela, 2003. "GPs' payment contracts and their referral practice," Journal of Health Economics, Elsevier, vol. 22(4), pages 617-635, July.
    12. Chandra, Amitabh & Cutler, David & Song, Zirui, 2011. "Who Ordered That? The Economics of Treatment Choices in Medical Care," Handbook of Health Economics, Elsevier.
    13. 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.
    14. Ellis, Randall P. & McGuire, Thomas G., 1990. "Optimal payment systems for health services," Journal of Health Economics, Elsevier, vol. 9(4), pages 375-396, December.
    15. Allard, Marie & Jelovac, Izabela & Léger, Pierre Thomas, 2011. "Treatment and referral decisions under different physician payment mechanisms," Journal of Health Economics, Elsevier, vol. 30(5), pages 880-893.
    16. Rabe-Hesketh, Sophia & Skrondal, Anders & Pickles, Andrew, 2005. "Maximum likelihood estimation of limited and discrete dependent variable models with nested random effects," Journal of Econometrics, Elsevier, vol. 128(2), pages 301-323, October.
    17. Valérie Paris & Marion Devaux & Lihan Wei, 2010. "Health Systems Institutional Characteristics: A Survey of 29 OECD Countries," OECD Health Working Papers 50, OECD Publishing.
    18. 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.
    19. Mark V. Pauly, 2004. "Competition in Medical Services and the Quality of Care: Concepts and History," International Journal of Health Economics and Management, Springer, vol. 4(2), pages 113-130, June.
    20. 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.
    21. Dranove, David & Wehner, Paul, 1994. "Physician-induced demand for childbirths," Journal of Health Economics, Elsevier, vol. 13(1), pages 61-73, March.
    22. 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.
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    Citations

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    Cited by:

    1. Kurt R. Brekke & Tor Helge Holmäs & Karin Monstad & Odd Rune Straume, 2017. "Competition and physician behaviour: Does the competitive environment affect the propensity to issue sickness certificates?," NIPE Working Papers 05/2017, NIPE - Universidade do Minho.
    2. repec:eee:jhecon:v:55:y:2017:i:c:p:244-261 is not listed on IDEAS
    3. Brosig-Koch, Jeannette & Hehenkamp, Burkhard & Kokot, Johanna, 2016. "The effects of competition on medical service provision," Annual Conference 2016 (Augsburg): Demographic Change 145589, Verein für Socialpolitik / German Economic Association.
    4. Schaumans, Catherine, 2015. "Prescribing behavior of General Practitioners: Competition matters," Health Policy, Elsevier, vol. 119(4), pages 456-463.
    5. Waibel, Christian & Wiesen, Daniel, 2016. "Kickbacks, referrals and efficiency in health care markets: Experimental evidence," HERO On line Working Paper Series 2016:8, Oslo University, Health Economics Research Programme.
    6. Dunn, Abe & Shapiro, Adam Hale, 2015. "Physician competition and the provision of care: evidence from heart attacks," Working Paper Series 2015-7, Federal Reserve Bank of San Francisco.
    7. 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.
    8. Sarah M. Hofmann & Andrea M. Mühlenweg, 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.
    9. 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.
    10. Markussen, Simen & Røed, Knut, 2017. "The market for paid sick leave," Journal of Health Economics, Elsevier, vol. 55(C), pages 244-261.
    11. repec:eee:jouret:v:90:y:2014:i:1:p:13-26 is not listed on IDEAS

    More about this item

    Keywords

    primary; care; physicians;

    JEL classification:

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

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