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Journal of Health Economics
Article . 2007 . Peer-reviewed
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Article . 2007
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Article . 2005 . Peer-reviewed
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Gatekeeping in Health Care

Authors: Kurt R. Brekke; Robert Nuscheler; Odd Rune Straume;

Gatekeeping in Health Care

Abstract

We study the competitive effects of restricting direct access to secondary care by gatekeeping, focusing on the informational role of general practitioners (GPs). In the secondary care market there are two hospitals choosing quality and specialization. Patients, who are ex ante uninformed, can consult a GP to receive an (imperfect) diagnosis and obtain information about the secondary care market. We show that hospital competition is amplified by higher GP attendance but dampened by improved diagnosing accuracy. Therefore, compulsory gatekeeping may result in excessive quality competition and too much specialization, unless the mismatch costs and the diagnosing accuracy are sufficiently high. Second-best price regulation makes direct regulation of GP consultation redundant, but will generally not implement first-best.

Countries
Germany, Portugal
Keywords

gatekeeping, imperfect information, quality competition, product differentiation, price regulation, Price regulation, Gesundheitswesen, Social Sciences, Product differentiation, quality competition, Hausarztsystem, Health Services Accessibility, gatekeeping, product differentiation, Humans, Physician's Role, L13, price regulation, Gatekeeping, Science & Technology, Economic Competition, Models, Statistical, I18, Imperfect information, ddc:330, I11, Quality competition, Physicians, Family, imperfect information, Europe, D82, Ärzte, Gesundheitspolitik, Delivery of Health Care, Theorie, jel: jel:D82, jel: jel:I11, jel: jel:I18, jel: jel:L13

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visibility
citations
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
views
OpenAIRE UsageCountsViews provided by UsageCounts
105
Top 10%
Top 10%
Average
2
Green
bronze