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The effects of competition on medical service provision

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  • Brosig-Koch, Jeannette
  • Hehenkamp, Burkhard
  • Kokot, Johanna

Abstract

We explore how competition between physicians affects medical service provision. Previous research has shown that, without competition, physicians deviate from patient-optimal treatment under payment systems like capitation and fee-for-service. While competition might reduce these distortions, physicians usually interact with each other repeatedly over time and only a fraction of patients switches providers at all. Both patterns might prevent competition to work in the desired direction. To analyze the behavioral effects of competition, we develop a theoretical benchmark which is then tested in a controlled laboratory experiment. Experimental conditions vary physician payment and patient characteristics. Real patients benefit from treatment decisions made in the experiment. Our results reveal that, in line with the theoretical prediction, introducing competition can reduce overprovision and underprovision, respectively. The observed effects depend on patient characteristics and the payment system, though. Tacit collusion is observed and particularly pronounced with fee-for-service payment, but it appears to be less frequent than in related experimental research on price competition.

Suggested Citation

  • Brosig-Koch, Jeannette & Hehenkamp, Burkhard & Kokot, Johanna, 2016. "The effects of competition on medical service provision," Ruhr Economic Papers 647, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
  • Handle: RePEc:zbw:rwirep:647
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    References listed on IDEAS

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    Cited by:

    1. Balafoutas, Loukas & Fornwagner, Helena & Kerschbamer, Rudolf & Sutter, Matthias & Tverdostup, Maryna, 2020. "Diagnostic Uncertainty and Insurance Coverage in Credence Goods Markets," IZA Discussion Papers 13848, Institute of Labor Economics (IZA).
    2. Johann Han & Nadja Kairies‐Schwarz & Markus Vomhof, 2017. "Quality competition and hospital mergers—An experiment," Health Economics, John Wiley & Sons, Ltd., vol. 26(S3), pages 36-51, December.
    3. Han, Johann & Kairies-Schwarz, Nadja & Vomhof, Markus, 2020. "Quality provision in competitive health care markets: Individuals vs. teams," Ruhr Economic Papers 839, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.

    More about this item

    Keywords

    physician competition; fee-for-service; capitation; laboratory experiment;

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • D43 - Microeconomics - - Market Structure, Pricing, and Design - - - Oligopoly and Other Forms of Market Imperfection
    • C91 - Mathematical and Quantitative Methods - - Design of Experiments - - - Laboratory, Individual Behavior
    • C72 - Mathematical and Quantitative Methods - - Game Theory and Bargaining Theory - - - Noncooperative Games

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