Competition in general practice: Prescriptions to the elderly in a list patient system

Kann, Inger Cathrine; Biørn, Erik; Lurås, Hilde

doi:10.1016/j.jhealeco.2010.07.004

Cited by 25 publications

(18 citation statements)

References 30 publications

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“…GPs are frequently profiled as economic agents who respond to economic incentives and are aware of the competitive structure of their environment [16,17]. Irish GPs are essentially independent contractors with considerable autonomy in how they choose to run their practices [18,19].…”

Section: Gps and Adoption Decision-makingmentioning

confidence: 99%

Prescribing and practice development decision-making in Irish general practices

Bourke

2015

Ir J Med Sci

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Section: Gps and Adoption Decision-makingmentioning

confidence: 99%

Prescribing and practice development decision-making in Irish general practices

Bourke

2015

Ir J Med Sci

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“…In addition, as an indicator of market structure, we construct a competition index, calculated as the number of GPs per 1,000 inhabitants (Kann, Biørn, Luras, 2010), and an index of population dependency on district hospitals, while geographical accessibility is proxied by population density. All these controls are entered at the district level.…”

Section: Figure 4 -Percentage Of Gps Receiving Financial Incentives Bmentioning

confidence: 99%

GPs and hospital expenditures. Should we keep expenditure containment programs alive?

Fiorentini

Bruni

Ugolini

2013

Social Science & Medicine

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Pay-for-performance programs offering additional payments to GPs can be used not only to improve the quality of care but also for cost containment purposes. In this paper, we analyse the impact of removing financial incentives in primary care that were aimed at containing hospital expenditure in the Italian region of Emilia Romagna during the period 2002-04. Our analysis draws on regional databanks linking GPs' characteristics to those of their patients (including all sources of public payments made to GPs), together with information on the utilisation of hospital services. We employ a difference-in-difference specification to assess changes in expenditures for avoidable and total hospital admissions. We identify the treatment group with GPs operating in districts where the program is withdrawn during the observation period ("Leavers"). Their performance is compared to that of two separate control groups, namely: GPs working in districts that grant incentives for the entire period ("Stayers"), and those working in districts that never introduced measures for the containment of hospitalisations ("Non Participants").The comparison between treatment and control groups shows that removing incentives does not result in a worse performance by Leavers compared to both control groups. This supports the policy of removing incentives, as such entail extra payments to GPs which, however, do not seem capable of significantly influencing their behaviour in the desired ways. Our findings complement previous evidence from the same institutional context showing that only those programs that aim to improve disease management for specific conditions -rather than to simply contain expenditure -have proven successful in reducing avoidable admissions for the target population.

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“…That is, we do not expect that the perceived benefits from adopting a new drug for the first time would be diminished by the stock of previous adopters (stock effect), or that adopting a new drug later in the adoption order would adversely impact on the benefit from adoption (order effects). However, health economics literature frequently profiles GPs as economic agents who respond to economic incentives and are aware of the competitive structure of their environment [32,33], so there may be some evidence of strategic interaction.…”

Section: Conceptual Frameworkmentioning

confidence: 99%

In with the new: the determinants of prescribing innovation by general practitioners in Ireland

Bourke

Roper

2011

Eur J Health Econ

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An important element of the process by which new drugs achieve widespread use is their adoption by GPs. In this paper, we explore the factors that shape the timing of the first prescription of six new drugs by General Practitioners in Ireland. Our analysis is based on a dataset that matches prescription data with data on GP characteristics. We then use duration analysis to explore both equilibrium and non-equilibrium determinants of prescribing innovation. Our study highlights a range of commonalities across all of the drugs considered and suggests the importance of GP and practice characteristics in shaping prescribing decisions. We also find strongly significant, and consistently signed, stock and order effects across these drugs: GPs who have a track record of early adoption tend also to be early adopters of other new drugs; and, the larger the proportion of GPs which have already adopted a new drug the slower is subsequent adoption. Epidemic and learning effects are also evident with slower adoption by rural practices and among those GPs with narrower prescribing portfolios.

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Competition in general practice: Prescriptions to the elderly in a list patient system

Cited by 25 publications

References 30 publications

Prescribing and practice development decision-making in Irish general practices

Prescribing and practice development decision-making in Irish general practices

GPs and hospital expenditures. Should we keep expenditure containment programs alive?

In with the new: the determinants of prescribing innovation by general practitioners in Ireland

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