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Competition, capitation and coding : Do public primary care providers respond to increased competition?

Dackehag, Margareta LU orcid and Ellegård, Lina Maria LU (2019) In CESifo Economic Studies 65(4). p.402-423
Abstract
The case for competition in health-care markets rests on economic models in which providers seek to maximize profits. However, little is known regarding how public health-care providers, who might not have a profit motive, react to increased competition from private providers. This study considers the heterogeneous effects of a primary health-care reform in a Swedish region that considerably loosened entry restrictions and increased patients’ freedom of choice, thus enabling increased competition. Our difference-in-differences analysis contrasts local markets that were affected by both entry and choice with local monopoly markets, which were unaffected by the reforms. Using detailed administrative data on all visits to public health... (More)
The case for competition in health-care markets rests on economic models in which providers seek to maximize profits. However, little is known regarding how public health-care providers, who might not have a profit motive, react to increased competition from private providers. This study considers the heterogeneous effects of a primary health-care reform in a Swedish region that considerably loosened entry restrictions and increased patients’ freedom of choice, thus enabling increased competition. Our difference-in-differences analysis contrasts local markets that were affected by both entry and choice with local monopoly markets, which were unaffected by the reforms. Using detailed administrative data on all visits to public health centers in 2008–2011, we find that providers in markets with increasing competition registered more diagnoses in an administrative database, thus increasing their reimbursement per patient. Although the economic significance of the effect is small, the result suggests that public providers are indeed sensitive to competition. (Less)
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author
and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
CESifo Economic Studies
volume
65
issue
4
pages
22 pages
publisher
Oxford University Press
external identifiers
  • scopus:85077740030
ISSN
1610-241X
DOI
10.1093/cesifo/ifz002
project
Public Management Research
language
English
LU publication?
yes
id
8179873e-070b-49ad-ae4d-b356bffd6d70
date added to LUP
2019-02-01 13:39:38
date last changed
2024-05-15 00:09:24
@article{8179873e-070b-49ad-ae4d-b356bffd6d70,
  abstract     = {{The case for competition in health-care markets rests on economic models in which providers seek to maximize profits. However, little is known regarding how public health-care providers, who might not have a profit motive, react to increased competition from private providers. This study considers the heterogeneous effects of a primary health-care reform in a Swedish region that considerably loosened entry restrictions and increased patients’ freedom of choice, thus enabling increased competition. Our difference-in-differences analysis contrasts local markets that were affected by both entry and choice with local monopoly markets, which were unaffected by the reforms. Using detailed administrative data on all visits to public health centers in 2008–2011, we find that providers in markets with increasing competition registered more diagnoses in an administrative database, thus increasing their reimbursement per patient. Although the economic significance of the effect is small, the result suggests that public providers are indeed sensitive to competition.}},
  author       = {{Dackehag, Margareta and Ellegård, Lina Maria}},
  issn         = {{1610-241X}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{402--423}},
  publisher    = {{Oxford University Press}},
  series       = {{CESifo Economic Studies}},
  title        = {{Competition, capitation and coding : Do public primary care providers respond to increased competition?}},
  url          = {{http://dx.doi.org/10.1093/cesifo/ifz002}},
  doi          = {{10.1093/cesifo/ifz002}},
  volume       = {{65}},
  year         = {{2019}},
}