The effect of financial incentives on gatekeeping doctors: Evidence from a natural experiment

Can increased primary care access reduce demand for emergency care? Evidence from England's 7-day GP opening

“…There is empirical evidence that fundholding changed GP practice patterns. Dusheiko et al (2006) find that patients of fundholding GPs were less satisfied with care, and more likely to agree that their doctor was more concerned about curbing costs. Croxson et al (2001) show that GPs had incentives to increase use of secondary care in the run up to fundholding to inflate their budgets.…”

Are private physicians more likely to veto generic substitution of prescribed pharmaceuticals?

“…Nassiri and Rochaix (2006) found that primary-care physicians in Quebec reacted both to temporary removal of expenditure caps and to changes in the relative price of consultations by changing their treatment pattern. Dusheiko, Gravelle, Jacobs and Smith (2006), studying the e¤ect of …nancial incentives on general medical practices in England, found that abolishing foundholding increased elective surgery by 3-5%. Leibowitz, Manning and Newhouse (1985) and Hellerstein (1998) used U.S. data to study the choice between prescribing brand-name or generic pharmaceuticals and found that the choice was not a function of the insurance plan; however, Leibowitz et al found that individuals with more generous insurance plans bought more prescription pharmaceuticals.…”

Do doctors charge high income patients more?

“…While doctors are consistently ranked as one of the most ethical and honest professions 2 studies have shown that, like other economic agents, doctors respond to financial incentives. For example, Croxson and Perkins (2001) and Dusheiko et al (2006) identify gaming behaviour by general practitioners (GPs) in the UK using natural experiments created by policy changes that altered the financial incentives for making non-emergency referrals to hospitals. Using variations in payment schemes, Gruber and Owings (1996) and Dumont et al (2008) find that doctors paid on a fee-for-service basis perform more medical services than those paid under salary or a mix of payment methods.…”