title: GPs' payment contracts and their referral practice.
abstract: This paper compares the role of general practitioners in determining access to specialists in two types of health care systems: gate-keeping systems, where a general practitioner (GP) referral is compulsory to visit a specialist, and non-gate-keeping systems, where this referral is optional. We model the dependence between the GP's diagnosis effort and her referral behaviour, and identify the optimal contracts that induce the best behaviour from a public insurer's point of view, where there is asymmetry of information between the insurer and the GP regarding diagnosis effort and referral decisions. We show that gate keeping is superior wherever GP's incentives matter.
authors.affiliation: Department of Economics, City University London, Northampton Square, London EC1V 0HB, UK. b.garcia-marinoso@city.ac.uk
authors.forename: Begoña Garcia
authors.initials: BG
authors.lastname: Mariñoso
authors.forename: Izabela
authors.initials: I
authors.lastname: Jelovac
mesh_terms: D005194:Family Practice / Q000191:economics* / Q000706:statistics & numerical data; D005380:Financing, Government; D020793:Gatekeeping / Q000191:economics* / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008511:Medicine / Q000706:statistics & numerical data; D017059:Models, Econometric; D009313:National Health Programs / Q000191:economics*; D010358:Patient Participation / Q000191:economics / Q000706:statistics & numerical data; D010819:Physician's Role; D016016:Proportional Hazards Models; D012017:Referral and Consultation / Q000191:economics* / Q000706:statistics & numerical data; D012052:Reimbursement, Incentive; D013038:Specialization