Scandinavian Working Papers in Economics

Memorandum,
Oslo University, Department of Economics

No 07/2009: The Gate is Open: Primary Care Physicians as Social Security Gatekeepers

Benedicte Carlsen and Karine Nyborg ()
Additional contact information
Benedicte Carlsen: The Rokkan Centre, University of Bergen, Postal: Nygårdsgt 5 , 5015 Bergen, Norway
Karine Nyborg: Dept. of Economics, University of Oslo, Postal: Department of Economics, University of Oslo, P.O Box 1095 Blindern, N-0317 Oslo, Norway

Abstract: Primary care physicians have two roles: the healer and the gatekeeper. We show that, due to information asymmetries, they cannot be expected to fulfill the latter role. Better gatekeepers will be poorer healers; hence all patients, both truly sick and shirkers, will strictly prefer physicians who give priority to healing. The choice between work and sick leave thus lies, essentially, with the patient. Interviews with Norwegian primary care physicians confirm this: Our interviewees report that shorter sick leaves are granted at request, while longer sick leaves are normally granted if the patient still prefer so after discussions with the physician.

Keywords: Sicklisting; subjective diagnoses; asymmetric information; focus group interviews.

JEL-codes: D11; D21; H42; I11; I18

26 pages, March 25, 2009

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