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Cut off from new competition: Threat of entry and health care quality

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  • Brüll, Eduard
  • Rostam-Afschar, Davud
  • Schlenker, Oliver

Abstract

We study how the threat of entry affects service quantity and quality of general practitioners (GPs). We leverage Germany's needs-based primary care planning system, in which the likelihood of new GPs reduces by 20 percentage points when primary care coverage exceeds a cut-off. We compile novel data covering all German primary care regions and up to 30,000 GP-level observations from 2014 to 2019. Reduced threat of entry lowers patient satisfaction for incumbent GPs without nearby competitors but not in areas with competitors. We find no effects on working hours or quality measures at the regional level including hospitalizations and mortality.

Suggested Citation

  • Brüll, Eduard & Rostam-Afschar, Davud & Schlenker, Oliver, 2024. "Cut off from new competition: Threat of entry and health care quality," Working Papers 41, University of Konstanz, Cluster of Excellence "The Politics of Inequality. Perceptions, Participation and Policies".
    • Handle: RePEc:zbw:cexwps:305253
    DOI: 10.48787/kops/352-2-14ko8qk55t1y6
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    References listed on IDEAS

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    1. McCann, Philip, 2001. "Urban and Regional Economics," OUP Catalogue, Oxford University Press, number 9780198776451.
    2. Nicholas Bloom & Carol Propper & Stephan Seiler & John Van Reenen, 2015. "The Impact of Competition on Management Quality: Evidence from Public Hospitals," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 82(2), pages 457-489.
    3. Austan Goolsbee & Chad Syverson, 2008. "How Do Incumbents Respond to the Threat of Entry? Evidence from the Major Airlines," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 123(4), pages 1611-1633.
    4. Godager, Geir & Iversen, Tor & Ma, Ching-to Albert, 2015. "Competition, gatekeeping, and health care access," Journal of Health Economics, Elsevier, vol. 39(C), pages 159-170.
    5. Catherine Schaumans & Frank Verboven, 2008. "Entry and regulation: evidence from health care professions," RAND Journal of Economics, RAND Corporation, vol. 39(4), pages 949-972, December.
    6. Mocetti, Sauro, 2016. "Dynasties in professions and the role of rents and regulation: Evidence from Italian pharmacies," Journal of Public Economics, Elsevier, vol. 133(C), pages 1-10.
    7. Leuven, Edwin & Oosterbeek, Hessel & de Wolf, Inge, 2013. "The effects of medical school on health outcomes: Evidence from admission lotteries," Journal of Health Economics, Elsevier, vol. 32(4), pages 698-707.
    8. Rita Santos & Hugh Gravelle & Carol Propper, 2017. "Does Quality Affect Patients’ Choice of Doctor? Evidence from England," Economic Journal, Royal Economic Society, vol. 127(600), pages 445-494, March.
    9. Mats A. Bergman & Niklas Rudholm, 2003. "The Relative Importance of Actual and Potential Competition: Empirical Evidence From the Pharmaceuticals Market," Journal of Industrial Economics, Wiley Blackwell, vol. 51(4), pages 455-467, December.
    10. Jeffrey T. Prince & Daniel H. Simon, 2015. "Do Incumbents Improve Service Quality in Response to Entry? Evidence from Airlines' On-Time Performance," Management Science, INFORMS, vol. 61(2), pages 372-390, February.
    11. Matias D. Cattaneo & Michael Jansson & Xinwei Ma, 2018. "Manipulation testing based on density discontinuity," Stata Journal, StataCorp LP, vol. 18(1), pages 234-261, March.
    12. David S. Lee & Thomas Lemieux, 2010. "Regression Discontinuity Designs in Economics," Journal of Economic Literature, American Economic Association, vol. 48(2), pages 281-355, June.
    13. Craig L. Garthwaite, 2012. "The Doctor Might See You Now: The Supply Side Effects of Public Health Insurance Expansions," American Economic Journal: Economic Policy, American Economic Association, vol. 4(3), pages 190-215, August.
    14. Goodman-Bacon, Andrew, 2021. "Difference-in-differences with variation in treatment timing," Journal of Econometrics, Elsevier, vol. 225(2), pages 254-277.
    15. Pike, Chris, 2010. "An Empirical Analysis of the Effects of GP Competition," MPRA Paper 27613, University Library of Munich, Germany.
    16. Kuhn, Michael & Ochsen, Carsten, 2019. "Population change and the regional distribution of physicians," The Journal of the Economics of Ageing, Elsevier, vol. 14(C).
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    More about this item

    Keywords

    Entry regulation; general practitioners; healthcare provision; threat of entry; regression discontinuity design;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • J44 - Labor and Demographic Economics - - Particular Labor Markets - - - Professional Labor Markets and Occupations
    • J22 - Labor and Demographic Economics - - Demand and Supply of Labor - - - Time Allocation and Labor Supply
    • L10 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - General
    • L22 - Industrial Organization - - Firm Objectives, Organization, and Behavior - - - Firm Organization and Market Structure
    • R23 - Urban, Rural, Regional, Real Estate, and Transportation Economics - - Household Analysis - - - Regional Migration; Regional Labor Markets; Population

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