title: Competition, gatekeeping, and health care access.
abstract: We study gatekeeping physicians' referrals of patients to specialty care. We derive theoretical results when competition in the physician market intensifies. First, due to competitive pressure, physicians refer patients to specialty care more often. Second, physicians earn more by treating patients themselves, so refer patients to specialty care less often. We assess empirically the overall effect of competition with data from a 2008-2009 Norwegian survey, National Health Insurance Administration, and Statistics Norway. From the data we construct three measures of competition: the number of open primary physician practices with and without population adjustment, and the Herfindahl-Hirschman index. The empirical results suggest that competition has negligible or small positive effects on referrals overall. Our results do not support the policy claim that increasing the number of primary care physicians reduces secondary care.
authors.affiliation: Department of Health Management and Health Economics, University of Oslo, Norway. Electronic address: geir.godager@medisin.uio.no.
authors.forename: Geir
authors.initials: G
authors.lastname: Godager
authors.affiliation: Department of Health Management and Health Economics, University of Oslo, Norway. Electronic address: tor.iversen@medisin.uio.no.
authors.forename: Tor
authors.initials: T
authors.lastname: Iversen
authors.affiliation: Department of Economics, Boston University, USA; University of Oslo, Norway. Electronic address: ma@bu.edu.
authors.forename: Ching-to Albert
authors.initials: CT
authors.lastname: Ma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004465:Economic Competition / Q000706:statistics & numerical data*; D005260:Female; D020793:Gatekeeping / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data*; D008875:Middle Aged; D009664:Norway; D058007:Physicians, Primary Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Competition; Gatekeeping; Primary care; Secondary care