Market conditions and general practitioners’ referrals

Iversen, Tor; Albert, Ching‐to

doi:10.1007/s10754-011-9101-y

Cited by 36 publications

(30 citation statements)

References 22 publications

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“…Also empirical studies are not consistent in their finding of an impact of competition on inducing behavior (Delattre and Dormont 2003, Carlson and Grytten 1998, Schaumans 2008) nor on quality of care (Sorensen andGrytten 1999, Pike 2010). Finally, Godager et al (2012) finds negligible or small positive effects on referrals to medical specialists, while Iversen and Ma (2011) find a positive impact of competition on radiology referrals .…”

Section: Introductionmentioning

confidence: 99%

“…This would confirm their health concern and indicates that the GP is taking it seriously. This argument is analogue to Iversen and Ma (2011), where a GP satisfies patients' requests for referrals to compete for patients and to retain them. Furthermore, putting on paper the exact names and quantities of medication to take, even though it can concern over-the-counter (OTC) drugs, can be seen as an extra service towards patients.…”

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confidence: 99%

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Prescribing behavior of General Practitioners: Competition matters

Schaumans

2015

Health Policy

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Background: General Practitioners have limited means to compete. As quality is hard to observe by patients, GPs have incentives to signal quality by using instruments patients perceive as quality. Objectives: We investigate whether GPs exhibit different prescribing behavior (volume and value of prescriptions) when confronted with more competition. As there is no monetary benefit in doing so, this type of (perceived) quality competition originates from GPs satisfying patients' expectations. Method: We look at market level data on per capita and per contact number of items prescribed by GPs and the value of prescriptions for the Belgian market of General Practitioners. We test to which extent different types of variables explain the observed variation. We consider patient characteristics, GP characteristics, number and type of GP contacts and the level of competition. The level of competition is measured by GP density, after controlling for the number of GPs and a HHI. Results: We find that a higher number of GPs per capita results in a higher number of units prescribed by GPs, both per capita and per contact. We argue that this is consistent with quality competition in the GP market. Our findings reject alternative explanations of GP scarcity, availability effect in GP care consumption and GP dispersing prescription in time due to competition.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

Prescribing behavior of General Practitioners: Competition matters

Schaumans

2015

Health Policy

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“…We employ the results of the referral-to-radiology model in Iversen and Ma (2011). To capture the possible treatment continuations upon a radiology test, a parameter β is utilized to represent the expected benefit from a treatment episode beginning with a radiology referral.…”

Section: A Model With Direct and Indirect Rationingmentioning

confidence: 99%

“…Hence, the GP's optimal referral rate is determined by the interval [β, 1] whereβ is the minimum expected benefit to initiate a referral. According to Iversen and Ma (2011),β is derived from the optimization of the GP's utility function that consists of the three elements. First, even though there is no fee for the referral, a referral may generate fees at a later stage when a patient comes back and the treatment is initiated.…”

Section: A Model With Direct and Indirect Rationingmentioning

confidence: 99%

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Supplementing gatekeeping with a revenue scheme for secondary care providers

Iversen

Mokienko

2016

Int J Health Econ Manag.

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We study implications of a change in the payment scheme for radiology providers in Norway that was implemented in 2008. The change implies reduced fee-for-service and increased fixed budget for a contracted volume of services. A consequence of the change is that private providers have less incentive to conduct examinations beyond the contracted volume. Different from the situation observed before the change in 2008, the volume is no longer determined by the demand side, and a rationing of the supply occurs. We employ data on radiological examinations initiated by GPs' referrals. We apply monthly data at the physician-practice level for 2007-2010. The data set is unique because it includes information about all GPs in the Norwegian patient-list system. The results indicate that private providers conducted fewer examinations in 2008-2010 compared with previous periods and that public hospitals did either the same volume or more. We find that GPs who operate in a more competitive environment experienced a greater reduction in magnetic resonance imaging, both performed by private providers and in total for their patients. We argue that this result supports a hypothesis that patients with lower expected benefits are rationed. Hence, rationing from the supply side might supplement GP gatekeeping.

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The Ambiguous Effect of GP Competition: The Case of Hospital Admissions

Islam

Kjerstad

2016

Health Economics

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SummaryIn the theoretical literature on general practitioner (GP) behaviour, one prediction is that intensified competition induces GPs to provide more services resulting in fewer hospital admissions. This potential substitution effect has drawn political attention in countries looking for measures to reduce the growth in demand for hospital care. However, intensified competition may induce GPs to secure hospital admissions a signal to attract new patients and to keep the already enlisted ones satisfied, resulting in higher admission rates at hospitals. Using both static and dynamic panel data models, we aim to enhance the understanding of whether such relations are causal. Results based on ordinary least square (OLS) models indicate that aggregate inpatient admissions are negatively associated with intensified competition both in the full sample and for the sub‐sample patients aged 45 to 69, while outpatient admissions are positively associated. Fixed‐effect estimations do not confirm these results though. However, estimations of dynamic models show significant negative (positive) effects of GP competition on aggregate inpatient (outpatient) admissions in the full sample and negative effects on aggregate inpatient admissions and emergency admissions for the sub‐sample. Thus, intensified GP competition may reduce inpatient hospital admissions by inducing GPs to provide more services, whereas, the alternative hypothesis seems valid for outpatient admissions. © 2016 The Authors. Health Economics Published by John Wiley & Sons, Ltd.

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Market conditions and general practitioners’ referrals

Cited by 36 publications

References 22 publications

Prescribing behavior of General Practitioners: Competition matters

Prescribing behavior of General Practitioners: Competition matters

Supplementing gatekeeping with a revenue scheme for secondary care providers

The Ambiguous Effect of GP Competition: The Case of Hospital Admissions

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