title: GP responses to price regulation: evidence from a French nationwide reform.
abstract: This paper uses a French reform to evaluate the impacts of overbilling restrictions on general practitioner (GP) care provision, fees and incomes. Since 1990, this reform has introduced conditions self-employed GPs must fulfil to be permitted to bill freely. We exploit 2005 and 2008 public health insurance administrative data on GP activity and fees. We use fuzzy regression discontinuity techniques to estimate local causal impacts for GPs who established practices in 1990 and who were constrained by the new regulation to charge regulated prices (compliers). We find that those GPs practices to income effects. In the regulated fee regime, GPs face prices lower by 42% and provide 50% more care than they would do in the unregulated fee regime. Male care provision increasing reaction is larger than the female one, which results in a higher male labour income in the regulated fee regime than with unregulated fees, whereas it is the opposite for women. With regulated fees, GPs limit side-salaried activities, use more lump-sum payment schemes and occupy more often gatekeeper positions.
authors.affiliation: CREST, France.
authors.forename: Elise
authors.initials: E
authors.lastname: Coudin
authors.affiliation: DREES, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Pla
authors.affiliation: LEDa-Legos, PSL, Université Paris Dauphine, France.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Samson
mesh_terms: D005251:Fees, Medical / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D005260:Female; D005602:France; D058005:General Practitioners / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D018166:Health Care Reform / Q000191:economics / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric
keywords: C21; GP activity; H51; causal evaluation; extra fees; fee-for-services; fuzzy regression discontinuity; jel I11; regulated/unregulated fee regimes