Supplementing gatekeeping with a revenue scheme for secondary care providers
We study implications of a change in the payment scheme for radiology providers in Norway that was implemented in 2008. The change implies reduced fee-for-service and increased fixed budget for a contracted volume of services. A consequence of the change is that private providers have less incentive to conduct examinations beyond the contracted volume. Different from the situation observed before the change in 2008, the volume is no longer determined by the demand side, and a rationing of the supply occurs. We employ data on radiological examinations initiated by GPs’ referrals. We apply monthly data at the physician-practice level for 2007–2010. The data set is unique because it includes information about all GPs in the Norwegian patient-list system. The results indicate that private providers conducted fewer examinations in 2008–2010 compared with previous periods and that public hospitals did either the same volume or more. We find that GPs who operate in a more competitive environment experienced a greater reduction in magnetic resonance imaging, both performed by private providers and in total for their patients. We argue that this result supports a hypothesis that patients with lower expected benefits are rationed. Hence, rationing from the supply side might supplement GP gatekeeping.
KeywordsPhysician Profit motive Referral Gatekeeping Fee-for-service Radiology
- Chandra, A., Cutler, D., & Song, Z. (2012). Who ordered that? The economics of treatment choices in medical care. In M. V. Pauly, T. G. McGuire, & P. P. Barros (Eds.), Handbook of Health Economics (Vol. 2, pp. 397–432). Amsterdam: Elsevier.Google Scholar
- DAMASK. (2007). Influence of magnetic resonance imaging of the knee on GPs’ decisions: A randomised trial. British Journal of General Practice, 57, 622–629.Google Scholar
- Scott, A. (2000). Economics of general practice. In A. J. Culyer & J. P. Newhouse (Eds.), Handbook of Health Economics (Vol. 1, pp. 1175–1200). Amsterdam: Elsevier.Google Scholar
- Siciliani, L., & Iversen, T. (2011). Waiting times and waiting lists. In A. Jones (Ed.), The Elgar companion to health economics (2nd ed.). Cheltenham: E. Elgar.Google Scholar
- Skinner, J. (2012). Causes and consequences of regional variations in health care. In M. V. Pauly, T. G. McGuire, & P. P. Barros (Eds.), Handbook of health economics (Vol. 2, pp. 45–93). Amsterdam: Elsevier.Google Scholar