Competition, Gatekeeping, and Health Care Access

Posted by D. Daniel Sokol

Godager, Geir (Department of Health Management and Health Economics) Iversen, Tor (Department of Health Management and Health Economics) and Albert Ma, Ching-to (Department of Economics, Boston University and University of Oslo) explore Competition, Gatekeeping, and Health Care Access

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 Herfindahl-Hirschman Index. We build a theoretical model, and derive two opposing effects of competition on gatekeeping physicians’ specialty referrals. The empirical results suggest that competition has negligible or small positive effects on referrals. Our results do not support the policy claim that increasing the number of primary care physicians reduces secondary care.