Scandinavian Working Papers in Economics

HERO On line Working Paper Series,
Oslo University, Health Economics Research Programme

No 2012:2: Competition, Gatekeeping, and Health Care Access

Geir Godager (), Tor Iversen () and Ching-to Albert Ma
Additional contact information
Geir Godager: Department of Health Management and Health Economics, Postal: HERO / Department of Health Management and Health Economics, P.O. Box 1089 Blindern, NO-0317 Oslo, Norway
Tor Iversen: Department of Health Management and Health Economics, Postal: HERO / Department of Health Management and Health Economics, P.O. Box 1089 Blindern, NO-0317 Oslo, Norway
Ching-to Albert Ma: Department of Economics, Boston University and University of Oslo

Abstract: We study the impact of competition on primary care physicians’specialty referrals. Our data come from a Norwegian survey in 2008-9 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 Her…ndahl-Hirschman Index. We build a theoretical model, and derive two opposing e¤ects of competition on gatekeeping physicians’ specialty referrals. The empirical results suggest that competition has negligible or small positive e¤ects on referrals. Our results do not support the policy claim that increasing the number of primary care physicians reduces secondary care.

Keywords: primary; care; physicians

JEL-codes: H51

30 pages, August 1, 2012

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