Discussion Paper Series in Economics, Department of Economics, Norwegian School of Economics (NHH)
Kurt R. Brekke
Competition and physician behaviour: Does the competitive environment the propensity to issue sickness certificates?
(), Tor Helge Holmås
(), Karin Monstad
() and Odd Rune Straume
Abstract: Competition among physicians is widespread, but compelling
empirical evidence on the impact on service provision is limited, mainly
due to lack of exogenous variation in the degree of competition. In this
paper we exploit that many GPs, in addition to own practice, work in local
emergency centres, where the matching of patients to GPs is random. This
allows us to observe the same GP in two different competitive environments;
with competition (own practice) and without competition (emergency centre).
Using rich administrative patient-level data from Norway for 2006-14, which
allow us to estimate high-dimensional fi…xed-effect models to control for
time-invariant patient and GP heterogeneity, we …nd that GPs with a
fee-for-service (…fixed salary) contract are 11 (8) percentage points more
likely to certify sick leave at own practice than at the emergency centre.
Thus, competition has a positive impact on GPs’sick listing that is
reinforced by …nancial incentives.
Keywords: Physicians; Competition; Sickness certification; (follow links to similar papers)
JEL-Codes: I11; I18; L13; (follow links to similar papers)
38 pages, February 12, 2017
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