Fixed fees and physician-induced demand: a panel data study on French physicians.

This paper investigates on the existence of physician-induced demand (PID) for French physicians. The test is carried out for GPs and specialists, using a representative sample of 4500 French self-employed physicians over the 1979-1993 period. These physicians receive a fee-for-services (FFS) payment and fees are controlled. The panel structure of our data allows us to take into account unobserved heterogeneity related to the characteristics of physicians and their patients. We use generalized method of moments (GMM) estimators in order to obtain consistent and efficient estimates. We show that physicians experience a decline of the number of consultations when they face an increase in the physician:population ratio. However this decrease is very slight. In addition, physicians counterbalance the fall in the number of consultations by an increase in the volume of care delivered in each encounter. Econometric results give a strong support for the existence of PID in the French system for ambulatory care.

[1]  L. Rochaix.  Information asymmetry and search in the market for physicians' services. , 1989, Journal of health economics.

[2]  M. Satterthwaite,et al.  The pricing of primary care physicians' services: a test of the role of consumer information , 1981 .

[3]  D. Dranove,et al.  Physician-induced demand for childbirths. , 1994, Journal of health economics.

[4]  T. Mcguire.  Chapter 9 – Physician Agency* , 2000 .

[5]  J. Schaafsma.  A new test for supplier-inducement and application to the Canadian market for dental care. , 1994, Journal of health economics.

[6]  Stephen Bond,et al.  Estimation in dynamic panel data models: Improving on the performance of the standard GMM estimator , 2000 .

[7]  R. Evans,et al.  Supplier-Induced Demand: Some Empirical Evidence and Implications , 1974 .

[8]  J. Green.  Physician-induced demand for medical care. , 1978, The Journal of human resources.

[9]  R. Blundell,et al.  Initial Conditions and Moment Restrictions in Dynamic Panel Data Models , 1998 .

[10]  M. Stano,et al.  Sources of small area variations in the use of medical care. , 1989, Journal of health economics.

[11]  F. Carlsen,et al.  More physicians: improved availability or induced demand? , 1998, Health economics.

[12]  Gail R. Wilensky,et al.  IDENTIFICATION OF PHYSICIAN-INDUCED DEMAND* , 1984 .

[13]  Timothy Besley,et al.  Alternative systems of health care provision , 1994 .

[14]  Brent R. Moulton.  An Illustration of a Pitfall in Estimating the Effects of Aggregate Variables on Micro Unit , 1990 .

[15]  Mark V. Pauly,et al.  Doctors and Their Workshops , 1980 .

[16]  J. Stock,et al.  Instrumental Variables Regression with Weak Instruments , 1994 .

[17]  Mark V. Pauly,et al.  Doctors and Their Workshops: Economic Models of Physician Behavior , 1981 .

[18]  Stanford,et al.  Working Paper Series THE SUPPLY OF SURGEONS AND THE DEMAND FOR OPERATIONS , 2002 .

[19]  T. Mcguire,et al.  Optimal payment systems for health services. , 1990, Journal of health economics.

[20]  Asher Wolinsky,et al.  Competition in a Market for Informed Experts' Services , 1993 .

[21]  J Grytten,et al.  Type of contract and supplier-induced demand for primary physicians in Norway. , 2001, Journal of health economics.

[22]  M. Arellano,et al.  Some Tests of Specification for Panel Data: Monte Carlo Evidence and an Application to Employment Equations , 1991 .

[23]  R. Sørensen,et al.  Competition and supplier-induced demand in a health care system with fixed fees. , 1999, Health economics.