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Choice in the presence of experts: the role of general practitioners in patients' hospital choice

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  • Walter Beckert

    () (Institute for Fiscal Studies and Birkbeck, University of London)

  • Kate Collyer

    (Institute for Fiscal Studies)

Abstract

This paper considers the micro-econometric analysis of patients' hospital choice for elective medical procedures when their choice set is pre-selected by a general practitioner (GP). It proposes a two-stage choice model that encompasses both, patient and GP level optimization, and it discusses identifi cation. The empirical analysis demonstrates biases and inconsistencies that arise when strategic pre-selection is not properly taken into account. We fi nd that patients defer to GPs when assessing hospital quality and focus on tangible attributes, like hospital amenities; and that GPs, in turn, as patients' agents present choice options based on quality, but as agents of health authorities also consider their financial implications.

Suggested Citation

  • Walter Beckert & Kate Collyer, 2016. "Choice in the presence of experts: the role of general practitioners in patients' hospital choice," IFS Working Papers W16/21, Institute for Fiscal Studies.
  • Handle: RePEc:ifs:ifsewp:16/21
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    References listed on IDEAS

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    1. Hausman, Jerry A & Wise, David A, 1979. "Attrition Bias in Experimental and Panel Data: The Gary Income Maintenance Experiment," Econometrica, Econometric Society, vol. 47(2), pages 455-473, March.
    2. Walter Beckert & Elaine Kelly, 2017. "Divided by choice? Private providers, patient choice and hospital sorting in the English National Health service," IFS Working Papers W17/15, Institute for Fiscal Studies.
    3. Alexandre Cornière & Greg Taylor, 2014. "Integration and search engine bias," RAND Journal of Economics, RAND Corporation, vol. 45(3), pages 576-597, September.
    4. Martin Gaynor & Rodrigo Moreno-Serra & Carol Propper, 2013. "Death by Market Power: Reform, Competition, and Patient Outcomes in the National Health Service," American Economic Journal: Economic Policy, American Economic Association, vol. 5(4), pages 134-166, November.
    5. Michael Dinerstein & Liran Einav & Jonathan Levin & Neel Sundaresan, 2018. "Consumer Price Search and Platform Design in Internet Commerce," American Economic Review, American Economic Association, vol. 108(7), pages 1820-1859, July.
    6. James J. Heckman, 1976. "The Common Structure of Statistical Models of Truncation, Sample Selection and Limited Dependent Variables and a Simple Estimator for Such Models," NBER Chapters, in: Annals of Economic and Social Measurement, Volume 5, number 4, pages 475-492, National Bureau of Economic Research, Inc.
    7. Gravelle, Hugh S & Propper, Carol & Santos, Rita, 2013. "Does quality affect patients’ choice of doctor? Evidence from the UK," CEPR Discussion Papers 9534, C.E.P.R. Discussion Papers.
    8. Leemore Dafny & Kate Ho & Mauricio Varela, 2013. "Let Them Have Choice: Gains from Shifting Away from Employer-Sponsored Health Insurance and toward an Individual Exchange," American Economic Journal: Economic Policy, American Economic Association, vol. 5(1), pages 32-58, February.
    9. Brekke, Kurt R. & Holmås, Tor Helge & Monstad, Karin & Straume, Odd Rune, 2017. "Competition and physician behaviour: Does the competitive environment the propensity to issue sickness certificates?," Discussion Paper Series in Economics 3/2017, Norwegian School of Economics, Department of Economics.
    10. Richard Blundell & James L. Powell, 2001. "Endogeneity in nonparametric and semiparametric regression models," CeMMAP working papers CWP09/01, Centre for Microdata Methods and Practice, Institute for Fiscal Studies.
    11. Rita Santos & Hugh Gravelle & Carol Propper, 2013. "Does quality affect patients’ choice of doctor? Evidence from the UK," Working Papers 088cherp, Centre for Health Economics, University of York.
    12. Griliches, Zvi & Ringstad, Vidar, 1970. "Error-in-the-Variables Bias in Nonlinear Contexts," Econometrica, Econometric Society, vol. 38(2), pages 368-370, March.
    13. Carol Propper & John Van Reenen, 2010. "Can Pay Regulation Kill? Panel Data Evidence on the Effect of Labor Markets on Hospital Performance," Journal of Political Economy, University of Chicago Press, vol. 118(2), pages 222-273, April.
    14. Walter Beckert & Mette Christensen & Kate Collyer, 2012. "Choice of NHS‐funded Hospital Services in England," Economic Journal, Royal Economic Society, vol. 122(560), pages 400-417, May.
    15. Nitin Mehta & Surendra Rajiv & Kannan Srinivasan, 2003. "Price Uncertainty and Consumer Search: A Structural Model of Consideration Set Formation," Marketing Science, INFORMS, vol. 22(1), pages 58-84, June.
    16. Liana Jacobi & Michelle Sovinsky, 2016. "Marijuana on Main Street? Estimating Demand in Markets with Limited Access," American Economic Review, American Economic Association, vol. 106(8), pages 2009-2045, August.
    17. Martin Gaynor & Carol Propper & Stephan Seiler, 2016. "Free to Choose? Reform, Choice, and Consideration Sets in the English National Health Service," American Economic Review, American Economic Association, vol. 106(11), pages 3521-3557, November.
    18. repec:ecj:econjl:v:122:y:2012:i::p:400-417 is not listed on IDEAS
    19. Michelle Sovinsky Goeree, 2008. "Limited Information and Advertising in the U.S. Personal Computer Industry," Econometrica, Econometric Society, vol. 76(5), pages 1017-1074, September.
    20. Zack Cooper & Stephen Gibbons & Simon Jones & Alistair McGuire, 2011. "Does Hospital Competition Save Lives? Evidence From The English NHS Patient Choice Reforms," Economic Journal, Royal Economic Society, vol. 121(554), pages 228-260, August.
    21. Peter Sivey, 2012. "The effect of waiting time and distance on hospital choice for English cataract patients," Health Economics, John Wiley & Sons, Ltd., vol. 21(4), pages 444-456, April.
    22. Siciliani, Luigi & Chalkley, Martin & Gravelle, Hugh, 2017. "Policies towards hospital and GP competition in five European countries," Health Policy, Elsevier, vol. 121(2), pages 103-110.
    23. Gowrisankaran, Gautam & Town, Robert J., 1999. "Estimating the quality of care in hospitals using instrumental variables," Journal of Health Economics, Elsevier, vol. 18(6), pages 747-767, December.
    24. Mark Armstrong & Jidong Zhou, 2011. "Paying for Prominence," Economic Journal, Royal Economic Society, vol. 121(556), pages 368-395, November.
    25. Markussen, Simen & Røed, Knut, 2017. "The market for paid sick leave," Journal of Health Economics, Elsevier, vol. 55(C), pages 244-261.
    26. E. Glen Weyl & Michal Fabinger, 2013. "Pass-Through as an Economic Tool: Principles of Incidence under Imperfect Competition," Journal of Political Economy, University of Chicago Press, vol. 121(3), pages 528-583.
    27. Andrei Hagiu & Bruno Jullien, 2011. "Why do intermediaries divert search?," RAND Journal of Economics, RAND Corporation, vol. 42(2), pages 337-362, June.
    28. Dana Goldman & John A. Romley, 2008. "Hospitals As Hotels: The Role of Patient Amenities in Hospital Demand," NBER Working Papers 14619, National Bureau of Economic Research, Inc.
    29. Dusheiko, Mark & Gravelle, Hugh & Jacobs, Rowena & Smith, Peter, 2006. "The effect of financial incentives on gatekeeping doctors: Evidence from a natural experiment," Journal of Health Economics, Elsevier, vol. 25(3), pages 449-478, May.
    30. 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.
    31. Alon Eizenberg, 2014. "Upstream Innovation and Product Variety in the U.S. Home PC Market," Review of Economic Studies, Oxford University Press, vol. 81(3), pages 1003-1045.
    32. Gutacker, Nils & Siciliani, Luigi & Moscelli, Giuseppe & Gravelle, Hugh, 2016. "Choice of hospital: Which type of quality matters?," Journal of Health Economics, Elsevier, vol. 50(C), pages 230-246.
    33. Kurt R. Brekke & Tor Helge Holmås & Karin Monstad & Odd Rune Straume, 2017. "Competition and Physician Behaviour: Does the Competitive Environment Affect the Propensity to Issue Sickness Certificates?," CESifo Working Paper Series 6672, CESifo Group Munich.
    34. Croxson, B. & Propper, C. & Perkins, A., 2001. "Do doctors respond to financial incentives? UK family doctors and the GP fundholder scheme," Journal of Public Economics, Elsevier, vol. 79(2), pages 375-398, February.
    35. Besanko, David & Perry, Martin K & Spady, Richard H, 1990. "The Logit Model of Monopolistic Competition: Brand Diversity," Journal of Industrial Economics, Wiley Blackwell, vol. 38(4), pages 397-415, June.
    36. Dusheiko, Mark & Gravelle, Hugh & Yu, Ning & Campbell, Stephen, 2007. "The impact of budgets for gatekeeping physicians on patient satisfaction: Evidence from fundholding," Journal of Health Economics, Elsevier, vol. 26(4), pages 742-762, July.
    37. Crawford, Gregory S. & Griffith, Rachel & Iaria, Alessandro, 2016. "Demand Estimation with Unobserved Choice Set Heterogeneity," CEPR Discussion Papers 11675, C.E.P.R. Discussion Papers.
    38. Daniel McFadden, 1977. "Modelling the Choice of Residential Location," Cowles Foundation Discussion Papers 477, Cowles Foundation for Research in Economics, Yale University.
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    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 2nd July 2018
      by Chris Sampson in The Academic Health Economists' Blog on 2018-07-02 11:00:43

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    Cited by:

    1. Walter Beckert & Elaine Kelly, 2021. "Divided by choice? For‐profit providers, patient choice and mechanisms of patient sorting in the English National Health Service," Health Economics, John Wiley & Sons, Ltd., vol. 30(4), pages 820-839, April.
    2. Charlotte Davies, 2020. "The supply side to procurement in a health market: competition and innovation in hip implants," Working Paper series, University of East Anglia, Centre for Competition Policy (CCP) 2020-01, Centre for Competition Policy, University of East Anglia, Norwich, UK..
    3. Soetevent, Adriaan R., 2021. "I’d Like to Move It! Consumption Rivalry in the EV Public Charging Market: Demand Estimation with Deterministic Choice Set Variation," EconStor Preprints 228520, ZBW - Leibniz Information Centre for Economics.

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    More about this item

    Keywords

    Discrete choice; patient; principal; GP; agent; expert; endogenous choice sets; competition; hospital choice; elective medical procedure.;
    All these keywords.

    JEL classification:

    • D12 - Microeconomics - - Household Behavior - - - Consumer Economics: Empirical Analysis
    • C51 - Mathematical and Quantitative Methods - - Econometric Modeling - - - Model Construction and Estimation
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • G11 - Financial Economics - - General Financial Markets - - - Portfolio Choice; Investment Decisions

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