Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-14T22:39:47.316Z Has data issue: false hasContentIssue false
  • English
  • Français

Does competition among general practitioners increase or decrease the consumption of specialist health care?

Published online by Cambridge University Press:  01 January 2010

Trond Tjerbo
Trond Tjerbo*
Affiliation:
Institute of Health Management and Health Economics, University of Oslo and the Norwegian Institute for Urban and Regional Research, Oslo, Norway
*
Correspondence to: Trond Tjerbo, Institute of Health Management and Health Economics, University of Oslo and the Norwegian Institute for Urban and Regional Research, P.O. Box 44, Blindern, N-0313 Oslo, Norway. Email: trond.tjerbo@nibr.no
Get access Rights & Permissions [Opens in a new window]

Abstract

Studies of the effects of capacity and competition among general practitioners (GPs) on the use of specialist health care services are inconclusive. Some studies indicate that an increase in the number of GPs leads to increased consumption of specialist health care, while other studies point in the opposite direction. This article adds to the literature in two ways; first by testing out different operationalization of capacity and competition among GPs, and then by testing out effects of capacity and competition on use of specialist health care services as this is disaggregated into ambulatory and inpatient activities. The empirical tests indicate that GP capacity in itself does not affect use of specialist health care services. Increased competitions among GPs do, however, reduce the use of ambulatory care while the effects on the use of inpatient services are unaffected.

Type
Articles
Information
Health Economics, Policy and Law , Volume 5 , Issue 1 , January 2010 , pp. 53 - 70
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Carlsen, B. (2006), ‘The changing role of gatekeepers: rationing and shared decision making in primary care’, PhD thesis, The Rokkan Centre, University of Bergen, Bergen.Google Scholar
Carlsen, F., Grytten, J., Kjelvik, J.Skau, I. (2006), ‘Bedre allmennlegetjeneste gir mindre bruk av spesialisthelsetjenester’ (Better GP services means less use of specialist health care services), Tidsskrift for Velferdssforskning, 9(3): 159–169.Google Scholar
Carlsen, B., Norheim, O. F. (2003), ‘Hvordan påvirker fastlegeordningen legens skjønnsmessige avgjørelser?’ (How does the general practitioner reform influence the physicians discretionary decisions?), Notatserie I Helseøkonomi nr 17/03. Health economic program Bergen (HEB), http://heb.rokkan.uib.no/publications/files/97-Notat17_03.pdf [Retrieved 10 July 2009].Google Scholar
Carlsen, B.Norheim, O. F. (2005), ‘ “Saying no is no easy matter”. A qualitative study of competing concerns in rationing decisions in general practice’, BMC Health Services Research, 5(70).CrossRefGoogle ScholarPubMed
Chaix-Couturier, C., Durand-Zalesky, I., Jolly, D.Durieux, P. (2000), ‘Effects of financial incentives on medical practice: results from a systematic review and methodological issues’, International Journal for Quality in Health Care, 12: 133–142.CrossRefGoogle ScholarPubMed
Domberger, S.Jensen, P. (1997), ‘Contracting out by the public sector: theory, evidence, prospects’, Oxford Review of Economic Policy, 13: 67–78.CrossRefGoogle Scholar
Elwyn, G. J.Stott, N. C. H. (1994), ‘Avoidable referrals? Analysis of 170 consecutive referrals to secondary care’, British Medical Journal, 309: 576–578.CrossRefGoogle Scholar
Fertig, A., Roland, M., King, H.Moore, T. (1993), ‘Understanding variation in rates of referrals among general practitioners: are inappropriate referrals important and would guidelines help to reduce them?’, British Medical Journal, 307(6917): 1467–1470.CrossRefGoogle Scholar
Finkel, S. (1995), Causal Analysis with Panel Data. Quantitative Applications in the Social Sciences, vol. 105, Thousand Oaks, California: Sage.CrossRefGoogle Scholar
Gafni, A., Charles, C.Whelan, T. (1998), ‘The physician–patient encounter: the physician as a perfect agent for the patient versus the informed treatment decision-making model’, Social Science and Medicine, 47(3): 347–354.CrossRefGoogle ScholarPubMed
Gravelle, H., Sutton, M., Morris, S., Windmeijer, F., Leyland, A., Dibben, C.Muirhead, M. (2003), ‘Modelling supply and demand influences on the use of health care: implications for deriving a needs-based capitation formula’, Journal of Health Economics, 12: 985–1004.CrossRefGoogle ScholarPubMed
Godager, G., Iversen, T., Lurås, H. (2007), ‘Fastlegeordningen Utvikling i bruk, tilgjengelighet og fornøydhet’ (The general practitioner system. The development in use, accessibility and satisfaction), HERO report no. 6, University of Oslo, Oslo.Google Scholar
Hickson, G. B., Altemeier, W. A.Perrin, J. A. (1987), ‘Physician reimbursement by salary or fee-for-service: effect on physician practice behavior in a randomized prospective study’, Pediatrics, 80: 344–350.CrossRefGoogle ScholarPubMed
Iversen, T.Kopperud, G. S. (2003), ‘The impact of accessibility on the use of specialist health care in Norway’, Health Care Management Science, 6: 249–261.CrossRefGoogle ScholarPubMed
Iversen, T., Lurås, H. (1998a), ‘The impact of economic motives on the provision of health services in general practice’, Working paper 1998:1, Center for Health Administration.Google Scholar
Iversen, T.Lurås, H. (1998b), ‘Innføring av fastlegeordning: hva med legenes tilpasning?’ (The introduction of the general practitioner reform: what about the physician’s adjustment?), Sosialøkonomen 52(7): 26–31.Google Scholar
Iversen, T.Lurås, H. (2000), ‘The effect of capitation on GP’s referral decisions’, Health Economics, 9: 199–210.3.0.CO;2-2>CrossRefGoogle Scholar
Jørgenvåg, R., Kjekshus, L. E. (2004), ‘Private avtalespesialister i Helse Øst RHF: Kapasitet, virksomhetsinnhold og rolle i behandlingskjeden’ (Private contract specialists in Eastern Norway Regional Health Authority: capacity, activity and role in the chain of treatment), Sintef report, Sintef Health Service research, Trondheim.Google Scholar
Kjekshus, L. E., Jørgenvåg, R. (2005), ‘Privatpraktiserende avtalespesialisters rolle i den sammenhengende behandlingskjeden: Om organisering bruk av avtalespesialister i helse Øst RHF’ (Private contract specialists’ role in the chain of treatment: The organization and use of contract specialists in Eastern Norway Regional Health Authority), Unpublished paper, HORN and Sintef Health Service Research.Google Scholar
Klein, R. (1993), ‘Dilemmas of rationing. Who should do what’, British Medical Journal, 307: 309–311.CrossRefGoogle Scholar
Kouides, R. W., Bennet, N. M., Lewis, B., Cappuccio, J. D., Barker, W. H.Marc LaForce, F. (1998), ‘Performance-based physician reimbursement and influenza immunization rates in the elderly: primary care physicians of Monroe county’, American Journal of Preventive Medicine, 14: 89–95.CrossRefGoogle ScholarPubMed
Krakauer, H., et al. (1996), ‘Physician impact on hospital admissions and on mortality rates in the Medicare Population’, Health Services Research, 31(2): 191–211.Google ScholarPubMed
Laditka, J. N., et al. (2005), ‘More may be better: evidence of a negative relationship between physician supply and hospitalization for ambulatory care sensitive conditions’, Health Services Research, 40(4): 1148–1166.CrossRefGoogle ScholarPubMed
Lurås, H.Iversen, T. (2002), ‘Legemangelen som ble pasientmangel: Variasjoner i listeønsker og pasientknapphet ved innføring av fastlegeordningen’ (The physician scarcity that turned into patient scarcity. Variation in preferred list length and patient scarcity with the introduction of the general practitioner reform), Økonomisk forum, 56(8): 26–31.Google Scholar
Lurås, H. (2004), ‘Hva vet vi om inntekstmotivert atferd blant fastleger?’ (What do we know about income generated behaviour amongst general practitioners?), Oral presentation, Den nasjonale helseøkonomikonferansen (The national health economic conference), Hurdal.Google Scholar
Mechanic, D. (2001), ‘Health Care, Rationing of', in N. J. Smelser and P. B. Baltes (eds), International Encyclopedia of the Social & Behavioral Sciences, Oxford: Pergamon: 6534–6537, ISBN 978-0-08-043076-8, DOI: 10.1016/B0-08-043076-7/03921-8 (http://www.sciencedirect.com/science/article/B7MRM-4MT09VJ-1Y4/2/3678f2dc655a61125723a03f94827a42).Google Scholar
Midttun, L. (2006), ‘Private or public? An empirical analysis of the importance of work values for work sector choice among Norwegian medical specialists’, Social Science and Medicine, 64: 1265–1277.CrossRefGoogle ScholarPubMed
Morris, S., et al. (2003), ‘Inequity and inequality in the use of health care in England: an empirical investigation’, CHE Technical papers series, University of York, York.Google Scholar
Nerland, S. M.Hagen, T. P. (2008), ‘Forbruk av spesialisthelsetjenester: ble det større likhet etter sykehusreformen?’ (Consumption of specialist health care: did the equality increase after the hospital reform?), Tidsskrift for Samfunnsforskning (1): 37–73.CrossRefGoogle Scholar
The Norwegian Medical Association (2000), ‘En sammenhengende helsetjeneste – fra stykkvis og delt til fullt og helt’ (A continuous health care system – from fragmented to whole), Helsepolitiske rapporter (Health political reports).Google Scholar
Norwegian Royal Commission no. 18 (2005), ‘Fordeling, forenkling, forbedring. Inntektssystemet for kommuner og fylkeskommuner’ (Allocation, simplification. Improvement. The income system for municipalites and counties).Google Scholar
Norwegian Royal Commission no. 2 (2008), ‘Fordeling av inntekter mellom regionale helseforetak’ (The allocation of revenues between the regional health authorities).Google Scholar
Reinhardt, U. (1989), ‘Economics in health care, saviors, or elephants in a porcelain shop?’, American Economic Review, 79: 337–342.Google ScholarPubMed
Ricketts, T. C., et al. (2001), ‘Hospitalization rates as indicators of access to primary care’, Health and Place, 7: 27–38.CrossRefGoogle Scholar
Ringard, Å., Rico, A., Hagen, T. P. (2006), ‘Introducing patient choice of hospital in National Health Systems a comparison of the UK and Norway’, HORN report no. 2, University of Oslo, Oslo.Google Scholar
Rizza, P., Bianco, A., Pavia, M.Angellillo, I. F. (2007), ‘Preventable hospitalization and access to primary health care in an area of Southern Italy’, BMC Health Services Research, 7: 134.CrossRefGoogle Scholar
Scott, A. (2000), ‘Economics of General Practice’, in J. P. Newhouse and A. J. Culyer (eds), Handbook of Health Economics, Amsterdam: Elsevier.Google Scholar
Scott, A.Vick, S. (2003), ‘Patients, doctors and contracts: an application of principal–agent theory to the doctor–patient relationship’, Scottish Journal of Political Economy, 46(2): 111–134.CrossRefGoogle Scholar
Shleifer, A. (1985), ‘A theory of yardstick competition’, The RAND Journal of Economics, 16(3): 319–327.CrossRefGoogle Scholar
Smith, P. (1997), ‘Principal–agent problems in health care systems: an international perspective’, Health Policy, 41(1): 37–60.CrossRefGoogle ScholarPubMed
Stano, M. (1985), ‘An analysis of the evidence of competition in the physician services market’, Journal of Health Economics, 4: 197–211.CrossRefGoogle Scholar
Vick, S.Scott, A. (1998), ‘Agency in health care. Examining patients’ preferences for attributes of the doctor–patient relationship’, Journal of Health Economics, 17(5): 587–605.CrossRefGoogle ScholarPubMed