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Analysing the effect of competition on General Practitioners' behaviour using a multilevel modelling framework

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  • Anthony Scott
  • Alan Shiell

Abstract

This paper examines the effect of competition on the behaviour of Australian general practitioners. The paper represents a considerable improvement on the methods of previous studies by using a random effects probit model in a multilevel modelling framework to obtain a more robust estimate of the effect of GP density, by including data on GP and practice characteristics and by using data with the actual GP consultation as the unit of observation which are disaggregated by medical condition. This latter characteristic enables us to test the hypothesis that the effect of competition varies across medical conditions. The main hypothesis tested is that GPs in areas of high competition are more likely to recommend a follow‐up consultation compared to GPs in areas of low competition. The results suggest that the density of GPs influences the decision to follow up for one out of the four medical conditions analysed. However, there are other issues to be resolved before such results can be confidently interpreted as evidence of the effect of competition and as evidence of supplier‐induced demand. © 1997 John Wiley & Sons, Ltd.

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  • Anthony Scott & Alan Shiell, 1997. "Analysing the effect of competition on General Practitioners' behaviour using a multilevel modelling framework," Health Economics, John Wiley & Sons, Ltd., vol. 6(6), pages 577-588, November.
    • Handle: RePEc:wly:hlthec:v:6:y:1997:i:6:p:577-588
    DOI: 10.1002/(SICI)1099-1050(199711)6:6<577::AID-HEC291>3.0.CO;2-Y
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    2. Scott, Anthony & Shiell, Alan, 1997. "Do fee descriptors influence treatment choices in general practice? A multilevel discrete choice model," Journal of Health Economics, Elsevier, vol. 16(3), pages 323-342, June.
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    Cited by:

    1. Lange, Ian, 2008. "Contract Parameters' Impacts on Coal Prices," Stirling Economics Discussion Papers 2008-26, University of Stirling, Division of Economics.
    2. Iversen, Tor, 2004. "The effects of a patient shortage on general practitioners' future income and list of patients," Journal of Health Economics, Elsevier, vol. 23(4), pages 673-694, July.
    3. Nigel Rice & Paul Dixon & David Lloyd & David Roberts, 1999. "Derivation of a needs based capitation formula for allocation prescribing budgets," Working Papers 034cheop, Centre for Health Economics, University of York.
    4. Kann, Inger Cathrine & Biørn, Erik & Lurås, Hilde, 2010. "Competition in general practice: Prescriptions to the elderly in a list patient system," Journal of Health Economics, Elsevier, vol. 29(5), pages 751-764, September.
    5. Julien Mousquès & Thomas Renaud & Olivier Scemama, 2008. "A refutation of the practice style hypothesis: the case of antibiotics prescription by French general practitioners for acute rhinopharyngitis," Working Papers DT18, IRDES institut for research and information in health economics, revised Oct 2008.
    6. Lurås, Hilde, 2009. "General Practice: Four Empirical Essays on GP Behaviour and Individuals’ Preferences for GPs," HERO Online Working Paper Series 2004:1, University of Oslo, Health Economics Research Programme.
    7. Alexander Ahammer & Ivan Zilic, 2017. "Do Financial Incentives Alter Physician Prescription Behavior? Evidence from Random Patient-GP Allocations," Working Papers 1701, The Institute of Economics, Zagreb.
    8. Denzil G. Fiebig & Rosalie Viney & Stephanie Knox & Marion Haas & Deborah J. Street & Arne R. Hole & Edith Weisberg & Deborah Bateson, 2017. "Consideration Sets and Their Role in Modelling Doctor Recommendations About Contraceptives," Health Economics, John Wiley & Sons, Ltd., vol. 26(1), pages 54-73, January.
    9. Julien Silhol & Bruno Ventelou & Anna Zaytseva, 2020. "How French general practitioners respond to declining medical density: a study on prescription practices, with an insight into opioids use," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(9), pages 1391-1398, December.
    10. Iversen, Tor & Lurås, Hilde, 2009. "The importance of micro-data for revaealing income motivated behaviour among GPs," HERO Online Working Paper Series 1999:3, University of Oslo, Health Economics Research Programme.
    11. Léonard, Christian & Stordeur, Sabine & Roberfroid, Dominique, 2009. "Association between physician density and health care consumption: A systematic review of the evidence," Health Policy, Elsevier, vol. 91(2), pages 121-134, July.
    12. Sundmacher, Leonie & Busse, Reinhard, 2011. "The impact of physician supply on avoidable cancer deaths in Germany. A spatial analysis," Health Policy, Elsevier, vol. 103(1), pages 53-62.
    13. Mangham-Jefferies, Lindsay & Hanson, Kara & Mbacham, Wilfred & Onwujekwe, Obinna & Wiseman, Virginia, 2014. "What determines providers' stated preference for the treatment of uncomplicated malaria?," Social Science & Medicine, Elsevier, vol. 104(C), pages 98-106.
    14. Fredrik Carlsson & Peter Martinsson, 2001. "Willingness to pay for reduction in air pollution: a multilevel analysis," Environmental Economics and Policy Studies, Springer;Society for Environmental Economics and Policy Studies - SEEPS, vol. 4(1), pages 17-27, March.
    15. Iversen, Tor & Luras, Hilde, 2000. "Economic motives and professional norms: the case of general medical practice," Journal of Economic Behavior & Organization, Elsevier, vol. 43(4), pages 447-470, December.

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