IDEAS home Printed from https://ideas.repec.org/p/iuj/wpaper/ems_2008_07.html
   My bibliography  Save this paper

Behavioral Difference between Self-Employed and Hospital-Employed Physicians in Japan

Author

Abstract

This paper presents a theoretical framework to describe the physicians' behavior under the fee-for-service scheme in Japan by explicitly incorporating the behavioral difference between self-employed and hospital-employed physicians into the model. One crucial assumption is found in the difference in the employment structure related to their income. The results show that self-employed physicians always provide unnecessary non-labor medical treatments, while hospital-employed physicians always give their patients the ideal level of the non-labor medical input. This study also presents that a substantial decline in the number of hospital-employed physicians results in an increase in physicians' overwork or unpaid work as well as in a decrease in the health level of the patients. This result could also be interpreted as a possible consequence of the reform of the Japanese trainee programme of physicians in 2004. We furthermore find that as long as the number of patients treated by both types of physicians is identical, hospital-employed physicians attain lower utility with heavier workloads but give better medical services with the higher health level of patients than self-employed physicians do.

Suggested Citation

  • Ryuta Ray Kato & Makoto Kakinaka, 2008. "Behavioral Difference between Self-Employed and Hospital-Employed Physicians in Japan," Working Papers EMS_2008_07, Research Institute, International University of Japan.
    • Handle: RePEc:iuj:wpaper:ems_2008_07
    as

    Download full text from publisher

    File URL: https://www.iuj.ac.jp/workingpapers/index.cfm?File=EMS_2008_07.pdf
    File Function: First version, 2008
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Chalkley, Martin & Malcomson, James M., 1998. "Contracting for health services when patient demand does not reflect quality," Journal of Health Economics, Elsevier, vol. 17(1), pages 1-19, January.
    2. Robert G. Evans, 1974. "Supplier-Induced Demand: Some Empirical Evidence and Implications," International Economic Association Series, in: Mark Perlman (ed.), The Economics of Health and Medical Care, chapter 10, pages 162-173, Palgrave Macmillan.
    3. Feldstein, Martin S, 1970. "The Rising Price of Physicians' Services," The Review of Economics and Statistics, MIT Press, vol. 52(2), pages 121-133, May.
    4. Pope, Gregory C., 1989. "Hospital nonprice competition and medicare reimbursement policy," Journal of Health Economics, Elsevier, vol. 8(2), pages 147-172, June.
    5. Makoto Kakinaka & Ryuta Ray Kato, 2008. "Intrinsic Motivation of Physicians," Working Papers EMS_2008_02, Research Institute, International University of Japan.
    6. repec:bla:jemstr:v:3:y:1994:i:1:p:71-92:a is not listed on IDEAS
    7. Ma, Ching-to Albert, 1994. "Health Care Payment Systems: Cost and Quality Incentives," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 3(1), pages 93-112, Spring.
    8. repec:bla:econom:v:66:y:1999:i:262:p:271-90 is not listed on IDEAS
    9. Ma, Ching-to Albert & McGuire, Thomas G, 1997. "Optimal Health Insurance and Provider Payment," American Economic Review, American Economic Association, vol. 87(4), pages 685-704, September.
    10. Wright, Donald J., 2007. "Specialist payment schemes and patient selection in private and public hospitals," Journal of Health Economics, Elsevier, vol. 26(5), pages 1014-1026, September.
    11. repec:bla:jemstr:v:3:y:1994:i:1:p:93-112:a is not listed on IDEAS
    12. Selden, Thomas M., 1990. "A model of capitation," Journal of Health Economics, Elsevier, vol. 9(4), pages 397-409, December.
    13. Glazer, Jacob & McGuire, Thomas G, 1994. "Payer Competition and Cost Shifting in Health Care," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 3(1), pages 71-92, Spring.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Makoto Kakinaka & Ryuta Kato, 2013. "Regulated medical fee schedule of the Japanese health care system," International Journal of Health Economics and Management, Springer, vol. 13(3), pages 301-317, December.
    2. Makoto Kakinaka & Ryuta Ray Kato, 2008. "Intrinsic Motivation of Physicians," Working Papers EMS_2008_02, Research Institute, International University of Japan.
    3. Chalkley, Martin & McVicar, Duncan, 2008. "Choice of contracts in the British National Health Service: An empirical study," Journal of Health Economics, Elsevier, vol. 27(5), pages 1155-1167, September.
    4. Jack, William, 2005. "Purchasing health care services from providers with unknown altruism," Journal of Health Economics, Elsevier, vol. 24(1), pages 73-93, January.
    5. Martin Chalkley & Duncan McVicar, 2001. "Contracts in the National Health Service: An Empirical Study," Dundee Discussion Papers in Economics 124, Economic Studies, University of Dundee.
    6. 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.
    7. Oddvar Kaarboe & Luigi Siciliani, 2011. "Multi‐tasking, quality and pay for performance," Health Economics, John Wiley & Sons, Ltd., vol. 20(2), pages 225-238, February.
    8. Boris Kralj & Jasmin Kantarevic, 2013. "Quality and quantity in primary care mixed-payment models: evidence from family health organizations in Ontario," Canadian Journal of Economics, Canadian Economics Association, vol. 46(1), pages 208-238, February.
    9. Carine Milcent, 2016. "Upcoding and heterogeneity in hospitals’ response: A Natural Experiment," PSE Working Papers halshs-01340557, HAL.
    10. Elin Johanna Gudrun Hafsteinsdottir & Luigi Siciliani, 2010. "DRG prospective payment systems: refine or not refine?," Health Economics, John Wiley & Sons, Ltd., vol. 19(10), pages 1226-1239, October.
    11. Carine Milcent, 2019. "From downcoding to upcoding: DRG based payment in hospitals," Working Papers halshs-02317416, HAL.
    12. Carine Milcent, 2021. "From downcoding to upcoding: DRG based payment in hospitals," International Journal of Health Economics and Management, Springer, vol. 21(1), pages 1-26, March.
    13. Hennig-Schmidt, Heike & Selten, Reinhard & Wiesen, Daniel, 2011. "How payment systems affect physicians' provision behaviour--An experimental investigation," Journal of Health Economics, Elsevier, vol. 30(4), pages 637-646, July.
    14. Tsuyoshi Takahara, 2016. "Patient dumping, outlier payments, and optimal healthcare payment policy under asymmetric information," Health Economics Review, Springer, vol. 6(1), pages 1-11, December.
    15. David Rudoler & Raisa Deber & Janet Barnsley & Richard H. Glazier & Adrian Rohit Dass & Audrey Laporte, 2015. "Paying for Primary Care: The Factors Associated with Physician Self‐selection into Payment Models," Health Economics, John Wiley & Sons, Ltd., vol. 24(9), pages 1229-1242, September.
    16. Mak, Henry Y., 2018. "Managing imperfect competition by pay for performance and reference pricing," Journal of Health Economics, Elsevier, vol. 57(C), pages 131-146.
    17. Martin Chalkley & Fahad Khalil, 2001. "Third Party Purchasing and Incentives: The "Outcome Movement" and Contracts for Health Services," Dundee Discussion Papers in Economics 125, Economic Studies, University of Dundee.
    18. Miller, Nolan H., 2006. "Insurer-provider integration, credible commitment, and managed-care backlash," Journal of Health Economics, Elsevier, vol. 25(5), pages 861-876, September.
    19. Kuhn, Michael & Siciliani, Luigi, 2008. "Upcoding and Optimal Auditing in Health Care (or The economics of DRG creep)," CEPR Discussion Papers 6689, C.E.P.R. Discussion Papers.
    20. Karen Eggleston, 2001. "Multitasking, Competition and Provider Payment," Discussion Papers Series, Department of Economics, Tufts University 0101, Department of Economics, Tufts University.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:iuj:wpaper:ems_2008_07. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Kazumi Imai, Office of Academic Affairs (email available below). General contact details of provider: https://edirc.repec.org/data/gsiujjp.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.