Gatekeeping in health care

Brekke, Kurt Richard; Nuscheler, Robert; Straume, Odd Rune

doi:10.1016/j.jhealeco.2006.04.004

Cited by 117 publications

(117 citation statements)

References 32 publications

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“…Seminal articles have presented theoretical models of GP behaviour (Ellis & McGuire, 1986;Harsanyi, 1955;McCombs, 1984;McGuire, 2000;Thornton & Eakin, 1997) and a substantial amount of empirical research has been conducted on the impact of organizational characteristics on delivery of GP services, focusing mostly on remuneration systems (Ellis & McGuire, 1990;Gosden et al, 2000;Laffont & Tirole, 1993) and the GP gate keeper role (Brekke et al, 2007;Dusheiko et al, 2006). However, much less is known about doctors' behaviour in publicly-oriented systems which have a high degree of focus on costcontainment and guidelines.…”

Section: Introductionmentioning

confidence: 99%

GPs' implicit prioritization through clinical choices – evidence from three national health services

Riise

Hole

Gyrd‐Hansen

et al. 2016

Journal of Health Economics

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We present results from an extensive discrete choice experiment, which was conducted in three countries (Norway, Scotland, and England) with the aim of disclosing stated prescription behaviour in different decision making contexts and across different cost containment cultures. We show that GPs in all countries respond to information about societal costs, benefits and effectiveness, and that they make trade-offs between them. The UK GPs have higher willingness to accept costs when they can prescribe medicines that are cheaper or more preferred by the patient, while Norwegian GPs tend to have higher willingness to accept costs for attributes regarding effectiveness or the doctors' experience. In general there is a substantial amount of heterogeneity also within each country. We discuss the results from the DCE in the light of the GPs' two conflicting agency roles and what we know about the incentive structures and cultures in the different countries.2

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Section: Introductionmentioning

confidence: 99%

GPs' implicit prioritization through clinical choices – evidence from three national health services

Riise

Hole

Gyrd‐Hansen

et al. 2016

Journal of Health Economics

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show abstract

“…Marinoso and Jelovac (2003) and Malcomson (2004) describe optimal contracts for gatekeepers, given that gatekeepers choose a level of diagnosis effort, and then may choose to treat or refer patients. Brekke et al (2007) focuses on the gatekeeper's role in allocating patients to the most appropriate secondary care provider (what we call experts). These papers do not address our topic: the financial and operational implications of aggregating or disaggregating and outsourcing the gatekeepers and experts.…”

Section: Literature Reviewmentioning

confidence: 99%

Outsourcing a Two-Level Service Process

2012

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This paper studies outsourcing decisions for a two-level service process in which the first level serves as a gatekeeper for a second level of experts. The objective of the system operator (the client) is to minimize the sum of staffing costs, customer waiting costs, and mistreatment costs due to unsuccessful attempts by a gatekeeper to solve the customer's problem. The client may outsource all or part of the process to a vendor, and first-best contracts exist when the client outsources only gatekeepers or experts. When the client outsources the entire system as a two-level process, a client-optimal contract may not exist unless the exogenous system parameters satisfy a particular (and unlikely) coordination condition. In addition, optimal incentive-compatible contracts exist when the vendor's structure choice (one-level or two-level) can deviate from the client's preference.Finally, we numerically examine how vendor structure choice and labor cost advantages influence the client's optimal outsourcing option.

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“…Dick (2007) a negative correlation using UK data. 4 Clearly, the spatial competition framework we use in our analysis is relevant for many markets, including the speci…c ones mentioned above. In retail markets, for example, outlets are spatially di¤erentiated due to di¤erent physical locations, and retailers may use price and service (quality) in order to get consumers to buy from them.…”

Section: Introductionmentioning

confidence: 99%

Price and quality in spatial competition

Brekke

Siciliani

Straume

2010

Regional Science and Urban Economics

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We study the relationship between competition and quality within a spatial competition framework where …rms compete in prices and quality. We generalise existing literature on spatial price-quality competition along several dimensions, including utility functions that are non-linear in income and cost functions that are non-separable in output and quality. Our main message is that the scope for a positive relationship between competition and quality is underestimated in the existing literature. If we allow for income e¤ects by assuming that utility is strictly concave in income, we …nd that lower transportation costs always lead to higher quality. The presence of income e¤ects might also reverse a previously reported negative relationship between the number of …rms and equilibrium quality. This reversal result is further strenghtened if there are cost substitutabilities between output and quality. Equilibrium quality provision is always less than socially optimal in the presence of income e¤ects.

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Gatekeeping in health care

Cited by 117 publications

References 32 publications

GPs' implicit prioritization through clinical choices – evidence from three national health services

GPs' implicit prioritization through clinical choices – evidence from three national health services

Outsourcing a Two-Level Service Process

Price and quality in spatial competition

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