Physician dual practice and the public health care provision. Review of the literature
Objectives: A combination of public and private clinical practice by physicians, referred to as physician dual practice, is present in numerous health care systems. The phenomenon has been receiving attention in connection with arguments about its negative impact for the public provision of health care. A ban or restrictions on dual practice is widely advocated. The aim of this paper is to review and critically discuss the empirical and theoretical findings on the subject of physician dual practice and its effects for the provision of public health care. Methods: A systematic literature review, using electronic and manual searches, identified 23 positions on the subject of physician dual practice consisting of peer-reviewed journal articles, including two review articles on selected aspects of dual practice, academic working papers, book chapters, and WHO publications. Results: The subject is short on hard evidence. Theoretical analyses of dual practice impact on public health care provision shows that dual practice might bring about both positive and negative effects. Some of the conclusions on the negative effects of dual practice, however, depend on assumptions, which are questioned in broader economic literature. Moreover, while it seems that dual practitioners take up private practice predominantly to increase their income, it does not automatically imply that dual practice as a whole is a profit-maximising combination. Physicians seem to face promising opportunities in the private market. Still, they spend relatively little time in the private practice and supply labour to the lower paid public sector job. Eventually, the potential costs and effectiveness of dual practice regulation are rarely considered. Conclusions: Further research is needed into why physicians engage in dual practice and whether potential costs of dual practice outweigh the costs of enforcing restrictions on dual practice. A promising direction appears to be an analysis comparing the behaviour of the public sector physicians with and without dual practice, respectively, in a given institutional settings and under uniform assumptions about the objectives of the physicians in these two groups. Moreover, it seems useful to employ the labour economics framework for multiple job holding in the analysis of the dual practice effects. This framework helps to recognise that physicians holding two jobs might be different from single job holding physicians with regard to the most preferred combination of income and leisure, which implies differences in labour market participation constraints and marginal costs of labour/effort between the two groups.
|Date of creation:||01 Oct 2010|
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- Pau Olivella Cunill & Pedro Pita Barros, 2000.
"Waiting Lists and Patient Selection,"
Econometric Society World Congress 2000 Contributed Papers
0283, Econometric Society.
- Barros, Pedro Luis Pita, 2000. "Waiting Lists and Patient Selection," CEPR Discussion Papers 2519, C.E.P.R. Discussion Papers.
- Pedro Pita Barros & Pau Olivella, . "Waiting Lists And Patient Selection," UFAE and IAE Working Papers 444.99, Unitat de Fonaments de l'Anàlisi Econòmica (UAB) and Institut d'Anàlisi Econòmica (CSIC).
- Paula González, 2005. "On a policy of transferring public patients to private practice," Health Economics, John Wiley & Sons, Ltd., vol. 14(5), pages 513-527.
- 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.
- Gary Biglaiser & Ching-to Albert Ma, 2006. "Moonlighting: Public Service and Private Practice," Working Papers 12, Portuguese Competition Authority.
- Gary Biglaiser & Ching-to Albert Ma, 2006. "Moonlighting: Public Service and Private Practice," Boston University - Department of Economics - Working Papers Series WP2006-015, Boston University - Department of Economics.
- 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.
- Jean Kimmel & Karen Smith Conway, 1995. "Who Moonlights and Why?: Evidence from the SIPP," Upjohn Working Papers and Journal Articles 95-40, W.E. Upjohn Institute for Employment Research.
- Kurt R. Brekke & Lars Sørgard, 2007.
"Public versus private health care in a national health service,"
John Wiley & Sons, Ltd., vol. 16(6), pages 579-601.
- Kurt R. Brekke & Lars Sørgard, 2006. "Public versus Private Health Care in a National Health Service," CESifo Working Paper Series 1679, CESifo Group Munich.
- Lundborg, Per, 1991.
"Job Amenity and the Incidence of Double Work,"
Working Paper Series
291, Research Institute of Industrial Economics.
- McGuire, Thomas G., 2000. "Physician agency," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 9, pages 461-536 Elsevier.
- Blomqvist, Ake, 1991. "The doctor as double agent: Information asymmetry, health insurance, and medical care," Journal of Health Economics, Elsevier, vol. 10(4), pages 411-432.
- Gruen, Reinhold & Anwar, Raqibul & Begum, Tahmina & Killingsworth, James R. & Normand, Charles, 2002. "Dual job holding practitioners in Bangladesh: an exploration," Social Science & Medicine, Elsevier, vol. 54(2), pages 267-279, January.
- Garcia-Prado, Ariadna & Gonzalez, Paula, 2007. "Policy and regulatory responses to dual practice in the health sector," Health Policy, Elsevier, vol. 84(2-3), pages 142-152, December.
- 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.
- Joseph P. Newhouse, 1996. "Reimbursing Health Plans and Health Providers: Efficiency in Production versus Selection," Journal of Economic Literature, American Economic Association, vol. 34(3), pages 1236-1263, September.
- Ellis, Randall P. & McGuire, Thomas G., 1986. "Provider behavior under prospective reimbursement : Cost sharing and supply," Journal of Health Economics, Elsevier, vol. 5(2), pages 129-151, June.
- Rickman, Neil & McGuire, Alistair, 1999. "Regulating Providers' Reimbursement in a Mixed Market for Health Care," Scottish Journal of Political Economy, Scottish Economic Society, vol. 46(1), pages 53-71, February.
- McAvinchey, Ian D & Yannopoulos, Andreas, 1994. "A Cost Function Approach to the Choice between Private and Public Acute Health Care Provision," Scottish Journal of Political Economy, Scottish Economic Society, vol. 41(2), pages 194-211, May.
- Martinussen, Pål E. & Hagen, Terje P., 2009. "Reimbursement systems, organisational forms and patient selection: Evidence from day surgery in Norway," Health Economics, Policy and Law, Cambridge University Press, vol. 4(02), pages 139-158, April.
- Shishko, Robert & Rostker, Bernard, 1976. "The Economics of Multiple Job Holding," American Economic Review, American Economic Association, vol. 66(3), pages 298-308, June.
- Susan Averett, 2001. "Moonlighting: multiple motives and gender differences," Applied Economics, Taylor & Francis Journals, vol. 33(11), pages 1391-1410.
- Paula González, 2004. "Should physicians' dual practice be limited? An incentive approach," Health Economics, John Wiley & Sons, Ltd., vol. 13(6), pages 505-524.
- Anupa Bir & Karen Eggleston, 2003. "Physician Dual Practice: Access Enhancement or Demand Inducement?," Discussion Papers Series, Department of Economics, Tufts University 0311, Department of Economics, Tufts University.
- Antonia Morga & Ana Xavier, . "Hospital specialists' private practice and its impact on the number of NHS patients treated and on the delay for elective surgery," Discussion Papers 01/01, Department of Economics, University of York.
- Ellis, Randall P., 1998. "Creaming, skimping and dumping: provider competition on the intensive and extensive margins1," Journal of Health Economics, Elsevier, vol. 17(5), pages 537-555, October.
- De Pietro, Carlo, 2006. "Private medical services in the Italian public hospitals: The case for improving HRM," Health Policy, Elsevier, vol. 78(1), pages 56-69, August.
- Smith Conway, Karen & Kimmel, Jean, 1998. "Male labor supply estimates and the decision to moonlight," Labour Economics, Elsevier, vol. 5(2), pages 135-166, June.
- Cullis, John G. & Jones, Philip R. & Propper, Carol, 2000. "Waiting lists and medical treatment: Analysis and policies," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 23, pages 1201-1249 Elsevier.
- Eggleston, Karen & Bir, Anupa, 2006. "Physician dual practice," Health Policy, Elsevier, vol. 78(2-3), pages 157-166, October.
- Gal-Or, Esther, 1999. "Optimal Reimbursement and Malpractice Sharing Rules in Health Care Markets," Journal of Regulatory Economics, Springer, vol. 16(3), pages 237-65, November.
- Randall P. Ellis & Thomas G. McGuire, 1993. "Supply-Side and Demand-Side Cost Sharing in Health Care," Journal of Economic Perspectives, American Economic Association, vol. 7(4), pages 135-151, Fall.
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