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Choice in the presence of experts: The role of general practitioners in patients’ hospital choice

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  • Beckert, Walter

Abstract

This paper considers the micro-econometric analysis of patients’ hospital choice for elective medical procedures when their choice set is pre-selected by a general practitioner (GP). GPs have a dual role with regard to elective referrals in the English NHS, advising patients and at the same time taking account of the financial implications of referral decisions on local health budgets. The paper proposes a two-stage choice model that encompasses both patient and GP level optimization. It demonstrates that estimators that do not take account of strategic pre-selection of choice sets may be biased and inconsistent. We find that GPs as patients’ agents select choice options based on quality, but as agents of health authorities also consider financial implications of referrals. When considering these choice options, patients focus on tangible hospital attributes, like amenities.

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  • Beckert, Walter, 2018. "Choice in the presence of experts: The role of general practitioners in patients’ hospital choice," Journal of Health Economics, Elsevier, vol. 60(C), pages 98-117.
    • Handle: RePEc:eee:jhecon:v:60:y:2018:i:c:p:98-117
    DOI: 10.1016/j.jhealeco.2018.06.003
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    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 2nd July 2018
      by Chris Sampson in The Academic Health Economists' Blog on 2018-07-02 11:00:43

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    2. Charlotte Davies, 2020. "The supply side to procurement in a health market: competition and innovation in hip implants," Working Paper series, University of East Anglia, Centre for Competition Policy (CCP) 2020-01, Centre for Competition Policy, University of East Anglia, Norwich, UK..
    3. Susan J. Méndez & Jongsay Yong & Hugh Gravelle & Anthony Scott, 2024. "Medical pricing decisions: Evidence from Australian specialists," Melbourne Institute Working Paper Series wp2024n11, Melbourne Institute of Applied Economic and Social Research, The University of Melbourne.
    4. Davies, Charlotte & Davies, Stephen, 2021. "Assessing competition in the hip implant industry in the light of recent policy guidance," Social Science & Medicine, Elsevier, vol. 287(C).
    5. Chen, Qiulin & Xu, Duo & Fu, Hongqiao & Yip, Winnie, 2022. "Distance effects and home bias in patient choice on the Internet: Evidence from an online healthcare platform in China," China Economic Review, Elsevier, vol. 72(C).
    6. Zhang, Mengdan & Zhang, Chonghui & Shi, Qiule & Zeng, Shouzhen & Balezentis, Tomas, 2022. "Operationalizing the telemedicine platforms through the social network knowledge: An MCDM model based on the CIPFOHW operator," Technological Forecasting and Social Change, Elsevier, vol. 174(C).
    7. Giuseppe Moscelli & Hugh Gravelle & Luigi Siciliani, 2021. "Hospital competition and quality for non‐emergency patients in the English NHS," RAND Journal of Economics, RAND Corporation, vol. 52(2), pages 382-414, June.
    8. Soetevent, Adriaan R., 2021. "I’d Like to Move It! Consumption Rivalry in the EV Public Charging Market: Demand Estimation with Deterministic Choice Set Variation," EconStor Preprints 228520, ZBW - Leibniz Information Centre for Economics.
    9. Devesh Raval & Ted Rosenbaum & Nathan E. Wilson, 2022. "Using disaster‐induced closures to evaluate discrete choice models of hospital demand," RAND Journal of Economics, RAND Corporation, vol. 53(3), pages 561-589, September.
    10. Devesh Raval & Ted Rosenbaum, 2021. "Why is Distance Important for Hospital Choice? Separating Home Bias From Transport Costs," Journal of Industrial Economics, Wiley Blackwell, vol. 69(2), pages 338-368, June.

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    More about this item

    Keywords

    Discrete choice; Patient; Principal; GP; Agent; Expert; Endogenous choice sets; Competition; Hospital choice; Elective medical procedure;
    All these keywords.

    JEL classification:

    • D12 - Microeconomics - - Household Behavior - - - Consumer Economics: Empirical Analysis
    • C51 - Mathematical and Quantitative Methods - - Econometric Modeling - - - Model Construction and Estimation
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • G11 - Financial Economics - - General Financial Markets - - - Portfolio Choice; Investment Decisions

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