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The relationship between dual practice and physicians’ work behaviour in the public hospitals: Results from the Danish survey

Listed author(s):
  • Socha, Karolina


    (COHERE, Department of Business and Economics)

  • Bech, Mickael


    (COHERE, Department of Budiness and Economics)

In numerous healthcare systems, some physicians combine public hospital employment with a private practice - a phenomenon referred to as physician dual practice. Dual practice raises numerous concerns with regard to its possible negative effects on the work performance of physicians in public hospitals. The purpose of this study is to test the theoretical predictions with regards to the dual-practice effects on work inputs of public hospital physicians. We use a crosssectional data on physicians work inputs from a 2008 nation representative survey of public hospital physicians in Denmark. To tackle the limitations imposed by the cross-sectional character of the data and the self-(selection) problem we employ a multilevel mixed model. Multilevel modelling is a Bayesian alternative to the frequentist models of causal inference from observational data such as simultaneous equation or matching methods, including propensity score analysis. The multilevel mixed model gives the relationship between dual practice and the physicians’ behaviour in the public hospitals, controlling for confounders such as a hospital type, medical specialty, position, income, age, gender, and years of working experience, as well as potential confounders related to all these background characteristics. The results do not reveal any patterned relationship between dual practice and public hospital work hours, participation in voluntary tasks or activities that might conflict with the private-practice hours, or preferences for part-time employment. The results also do not support the general presumption that the physicians who work exclusively in public hospitals are more altruistic and hence, voluntarily provide more work inputs than dual-practitioners. The causal inference with the current data is challenging, especially in the view of the labour economics and personnel economics studies on dual job holding, which suggest that dual and single jobholders represent different types of personality, with the dual jobholders being the more proactive employees. The current analysis does not account for the possible differences in the personality, hence it cannot be excluded that the dual-practitioners change someway their work behaviour in public hospitals after the commencement of dual practice. Still, it can be concluded that physicians engaged in dual practice perform at least as good in the public hospitals as their counterparts who do not hold a second job.

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Paper provided by COHERE - Centre of Health Economics Research, University of Southern Denmark in its series COHERE Working Paper with number 2011:1.

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Length: 21 pages
Date of creation: 01 Jan 2011
Handle: RePEc:hhs:sduhec:2011_001
Contact details of provider: Postal:
COHERE - Center for Sundhedsøkonomisk Forskning, Institut for Virksomhedsledelse og Økonomi, Syddansk Universitet, Campusvej 55, DK-5230 Odense M, Denmark

Phone: (+45) 6550 3081
Fax: (+45) 6550 3880
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  1. 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.
  2. 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.
  3. 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.
  4. Jason Abrevaya, 2006. "Estimating the effect of smoking on birth outcomes using a matched panel data approach," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 21(4), pages 489-519.
  5. Susan Averett, 2001. "Moonlighting: multiple motives and gender differences," Applied Economics, Taylor & Francis Journals, vol. 33(11), pages 1391-1410.
  6. 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.
  7. Martin, Stephen & Smith, Peter, 1996. "Explaining variations in inpatient length of stay in the National Health Service," Journal of Health Economics, Elsevier, vol. 15(3), pages 279-304, June.
  8. Kurt R. Brekke & Lars Sørgard, 2007. "Public versus private health care in a national health service," Health Economics, John Wiley & Sons, Ltd., vol. 16(6), pages 579-601.
  9. Guido W. Imbens, 2004. "Nonparametric Estimation of Average Treatment Effects Under Exogeneity: A Review," The Review of Economics and Statistics, MIT Press, vol. 86(1), pages 4-29, February.
  10. Shishko, Robert & Rostker, Bernard, 1976. "The Economics of Multiple Job Holding," American Economic Review, American Economic Association, vol. 66(3), pages 298-308, June.
  11. Markus Frölich, 2007. "On the inefficiency of propensity score matching," AStA Advances in Statistical Analysis, Springer;German Statistical Society, vol. 91(3), pages 279-290, October.
  12. Alberto Abadie & Guido W. Imbens, 2002. "Simple and Bias-Corrected Matching Estimators for Average Treatment Effects," NBER Technical Working Papers 0283, National Bureau of Economic Research, Inc.
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