Are Primary Care Physicians, Public and Private Sector Specialists Substitutes or Complements? Evidence from a Simultaneous Equations Model for Count Data

Atella, Vincenzo; Deb, Partha

doi:10.2139/ssrn.528722

Cited by 19 publications

(32 citation statements)

References 23 publications

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“…The regressors' coefficients (see table A1) are, with few exceptions, quite precisely estimated and consistent with previous empirical evidence on the determinants of visits counts (Pohlmeier and Ulrich (1995); Trivedi (1997, 2002); Fabbri and Monfardini (2003); Atella and Deb (2008)). Within our specification, the estimated demand elasticities represent partial demand responses to a small perturbation of the equilibrium in the local market for public and private consultancy (see Fabbri and Monfardini (2009)).…”

Section: Utilization Results: Demand Elasticitiessupporting

confidence: 86%

Opt Out or Top Up? Voluntary Healthcare Insurance and the Public vs. Private Substitution

Fabbri

Monfardini

2011

SSRN Journal

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ABSTRACT:We investigate whether people enrolled into voluntary health insurance (VHI) substitute public consumption with private (opt out) or just enlarge their private consumption, without reducing reliance upon public provisions (top up). We study the case of Italy, where a mixed insurance system is in place. To this purpose, we specify a joint model for public and private specialist visits counts, and allow for different degrees of endogenous supplementary insurance coverage, looking at the insurance coverage as driven by a trinomial choice process. We disentangle the effect of income and wealth by going through two channels: the direct impact on the demand for healthcare and that due to selection into VHI. We find evidence of opting out: richer and wealthier individuals consume more private services and concomitantly reduce those services publicly provided through selection into for-profit VHI. These results imply that the market for VHI eases the redistribution from high income (doubly insured) individuals to low income (not doubly insured) ones operated by the Italian National Health Service (NHS). Accounting for VHI endogeneity in the joint model of the two counts is crucial to this conclusion.J.E.L. classification: C34, C35, D12, H44, I11

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Section: Utilization Results: Demand Elasticitiessupporting

confidence: 86%

Opt Out or Top Up? Voluntary Healthcare Insurance and the Public vs. Private Substitution

Fabbri

Monfardini

2011

SSRN Journal

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“…On the contrary, P GP s are most likely to give referrals because of the existence of cooperation networks within the second (private) tier of the Austrian health care system (see Hypothesis 3). More precisely, P SP s consider expected referrals from P GP s, as confirmed by earlier studies by Atella and Deb (2008) or Gächter et al (2012). As expected, the exit of P SP s has a positive impact on the market entry of physicians of the same specialty.…”

Section: Resultssupporting

confidence: 76%

Entry Into the Physicians’ Market: Empirical Evidence From the Outpatient Sector in Austria

Gächter¹,

Schwazer²,

Theurl³

2013

Danube

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In forming strategies to improve the macro performance of health care systems, effective interaction between the public and private service provisions is considered an important aspect of institutional design. Recent economic research has provided valuable insights into the significance of this interaction. We study the market entry decisions of private physicians in the outpatient health care sector in Austria by applying an entry/exit model at two different spatial levels of aggregation and using data from the time period [2002][2003][2004][2005][2006][2007][2008]. By estimating a Poisson panel data model with community/district fixed effects, we find a significantly negative effect of existing physician capacities in a specialty, both in the public and private sectors, on the entry of new private physicians. On the contrary, we find a significantly positive effect of existing private general practitioners on the entry of private specialists. These findings indicate that private physicians tend to (i) compensate for regional differences in public outpatient capacities, and (ii) establish cooperative networks where they collaborate with other private physicians in the local market.

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“…Using data from Italy, Atella and Deb (2008) demonstrated that primary and specialist care are in fact substitutes. In Fortney et al (2005), primary care was found to be a complement for mental health services, a substitute for speciality care, and have a negative but statistically insignificant relationship with inpatient care.…”

Section: Theoretical Frameworkmentioning

confidence: 99%

Operating on commission: analyzing how physician financial incentives affect surgery rates

Shafrin

2009

Health Economics

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This paper employs a nationally representative, household-based dataset in order to test how the compensation method of both the specialists and the primary care providers affects surgery rates. After controlling for adverse selection, I find that when specialists are paid through a fee-for-system scheme rather than on a capitation basis, surgery rates increase 78%. The impact of primary care physician compensation on surgery rates depends on whether or not referral restrictions are present.

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Are Primary Care Physicians, Public and Private Sector Specialists Substitutes or Complements? Evidence from a Simultaneous Equations Model for Count Data

Cited by 19 publications

References 23 publications

Opt Out or Top Up? Voluntary Healthcare Insurance and the Public vs. Private Substitution

Opt Out or Top Up? Voluntary Healthcare Insurance and the Public vs. Private Substitution

Entry Into the Physicians’ Market: Empirical Evidence From the Outpatient Sector in Austria

Operating on commission: analyzing how physician financial incentives affect surgery rates

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