Competition and Physician Behaviour: Does the Competitive Environment Affect the Propensity to Issue Sickness Certificates?

49 Pages Posted: 25 Oct 2017

See all articles by Kurt Richard Brekke

Kurt Richard Brekke

Norwegian School of Economics (NHH) - Department of Economics; CESifo (Center for Economic Studies and Ifo Institute)

Tor Helge Holmas

University of Bergen - Department of Economics

Karin Monstad

Uni Research AS

Odd Rune Straume

University of Minho - Economic Policies Research Unit (NIPE); CESifo (Center for Economic Studies and Ifo Institute)

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Date Written: October 12, 2017

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 fixed-effect models to control for time-invariant patient and GP heterogeneity, we find that GPs with a fee-for-service (fixed-salary) contract are 12 (7.5) 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 strongly reinforced by financial incentives.

Keywords: physicians, competition, sickness certification

JEL Classification: I110, I180, L130

Suggested Citation

Brekke, Kurt Richard and Holmas, Tor Helge and Monstad, Karin and Straume, Odd Rune, Competition and Physician Behaviour: Does the Competitive Environment Affect the Propensity to Issue Sickness Certificates? (October 12, 2017). CESifo Working Paper Series No. 6672, Available at SSRN: https://ssrn.com/abstract=3058552

Kurt Richard Brekke

Norwegian School of Economics (NHH) - Department of Economics ( email )

Helleveien 30
N-5035 Bergen
Norway

CESifo (Center for Economic Studies and Ifo Institute)

Poschinger Str. 5
Munich, DE-81679
Germany

Tor Helge Holmas

University of Bergen - Department of Economics ( email )

Fosswinckelsgt. 6
N-5007 Bergen, 5007
Norway
+47 55589238 (Phone)
+47 55589210 (Fax)

HOME PAGE: http://www.econ.uib.no/stab/torHelge.html

Karin Monstad (Contact Author)

Uni Research AS ( email )

Uni Rokkan Centre
Nygårdsgaten 5
5015 Bergen
Norway

Odd Rune Straume

University of Minho - Economic Policies Research Unit (NIPE) ( email )

Campus de Gualtar
Braga, 4710-057
Portugal

CESifo (Center for Economic Studies and Ifo Institute)

Poschinger Str. 5
Munich, DE-81679
Germany

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