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Competition and supplier‐induced demand in a health care system with fixed fees

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  • Rune J. Sørensen
  • Jostein Grytten

Abstract

The present paper examines whether supplier‐induced demand exists for primary physician services in Norway. The research design is adapted to the institutional setting of Norwegian primary physician services, where there is a fixed fee schedule. More than 50% of primary care physicians receive a payment for treatment from the National Insurance Administration on a fee‐for‐item basis. The results showed that increased competition, measured as a high physician:population ratio, led to a decline in the number of consultations per contract physician. However, the contract physicians in high physician density areas did not compensate for the lack of patients by providing more items of treatment in order to maintain their income. Contract physicians’ revenue from items of treatment per consultation were unaffected both by physician density and by the number of consultations per contract physician. These results are further corroborated by data that showed that contract physicians’ gross revenue and profits were declining functions of physician density. This paper argues that, from an efficiency point of view, a deregulated health care market with fixed fees may operate well. Copyright © 1999 John Wiley & Sons, Ltd.

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  • Rune J. Sørensen & Jostein Grytten, 1999. "Competition and supplier‐induced demand in a health care system with fixed fees," Health Economics, John Wiley & Sons, Ltd., vol. 8(6), pages 497-508, September.
  • Handle: RePEc:wly:hlthec:v:8:y:1999:i:6:p:497-508
    DOI: 10.1002/(SICI)1099-1050(199909)8:6<497::AID-HEC439>3.0.CO;2-D
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    References listed on IDEAS

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    1. Fredrik Carlsen & Jostein Grytten, 1998. "More physicians: improved availability or induced demand?," Health Economics, John Wiley & Sons, Ltd., vol. 7(6), pages 495-508, September.
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    2. Schaumans, C.B.C., 2014. "Prescribing Behavior of General Practitioners : Competition Matters!," Other publications TiSEM 6d0d2ee7-fe03-41c3-89bc-8, Tilburg University, School of Economics and Management.
    3. Bernard Fortin & Nicolas Jacquemet & Bruce Shearer, 2008. "Policy Analysis in Health-Services Market: Accounting for Quality and Quantity," Annals of Economics and Statistics, GENES, issue 91-92, pages 293-319.
    4. Jostein Grytten & Fredrik Carlsen & Irene Skau, 2008. "Primary physicians’ response to changes in fees," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 9(2), pages 117-125, May.
    5. Tinglong Dai & Mustafa Akan & Sridhar Tayur, 2017. "Imaging Room and Beyond: The Underlying Economics Behind Physicians’ Test-Ordering Behavior in Outpatient Services," Manufacturing & Service Operations Management, INFORMS, vol. 19(1), pages 99-113, February.
    6. Sauerland, Dirk, 2001. "The German strategy for quality improvement in health care: still to improve," Health Policy, Elsevier, vol. 56(2), pages 127-147, May.
    7. 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.
    8. Sorensen, Rune J. & Grytten, Jostein, 2003. "Service production and contract choice in primary physician services," Health Policy, Elsevier, vol. 66(1), pages 73-93, October.
    9. Schaumans, Catherine, 2015. "Prescribing behavior of General Practitioners: Competition matters," Health Policy, Elsevier, vol. 119(4), pages 456-463.
    10. Jostein Grytten & Rune Sørensen, 2000. "Competition and dental services," Health Economics, John Wiley & Sons, Ltd., vol. 9(5), pages 447-461, July.
    11. Martin Chalkley & Colin Tilley, 2005. "The Existence and Nature of Physician Agency: Evidence of Stinting from the British National Health Service," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 14(3), pages 647-664, September.
    12. van Noort, Olivier & Schotanus, Fredo & van de Klundert, Joris & Telgen, Jan, 2018. "Explaining regional variation in home care use by demand and supply variables," Health Policy, Elsevier, vol. 122(2), pages 140-146.
    13. Christian Schmid, 2015. "Consumer Health Information and the Demand for Physician Visits," Health Economics, John Wiley & Sons, Ltd., vol. 24(12), pages 1619-1631, December.
    14. Adolf Kwadzo Dzampe & Shingo Takahashi, 2022. "Competition and physician-induced demand in a healthcare market with regulated price: evidence from Ghana," International Journal of Health Economics and Management, Springer, vol. 22(3), pages 295-313, September.
    15. Eric Delattre & Brigitte Dormont, 2003. "Fixed fees and physician‐induced demand: A panel data study on French physicians," Health Economics, John Wiley & Sons, Ltd., vol. 12(9), pages 741-754, September.
    16. Grytten, Jostein & Sorensen, Rune, 2007. "Primary physician services--List size and primary physicians' service production," Journal of Health Economics, Elsevier, vol. 26(4), pages 721-741, July.
    17. Grytten, Jostein & Sorensen, Rune, 2003. "Practice variation and physician-specific effects," Journal of Health Economics, Elsevier, vol. 22(3), pages 403-418, May.
    18. Grytten, Jostein & Sorensen, Rune, 2001. "Type of contract and supplier-induced demand for primary physicians in Norway," Journal of Health Economics, Elsevier, vol. 20(3), pages 379-393, May.
    19. Shinya Sugawara & Jiro Nakamura, 2014. "Incentive for Gatekeepers and Their Demand Inducement: An Empirical Analysis of Care Managers in the Japanese Long-Term Care Insurance," CIRJE F-Series CIRJE-F-916, CIRJE, Faculty of Economics, University of Tokyo.
    20. Schaumans, C.B.C., 2014. "Prescribing Behavior of General Practitioners : Competition Matters!," Other publications TiSEM c8445d1f-66f8-4238-835e-d, Tilburg University, School of Economics and Management.

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