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GPs' payment contracts and their referral practice.
Begoña Garcia Mariñoso1, Izabela Jelovac
1Department of Economics, City University London, Northampton Square, London EC1V 0HB, UK. b.garcia-marinoso@city.ac.uk
Journal of Health Economics
|July 5, 2003
Summary
Gate-keeping systems, requiring general practitioner (GP) referrals, are superior for specialist access when GP incentives are considered. This contrasts with non-gate-keeping systems where referrals are optional.
Area of Science:
- Health economics
- Healthcare systems analysis
- Public health policy
Background:
- General practitioners (GPs) play a crucial role in healthcare access.
- Two primary models exist: gate-keeping (compulsory GP referral) and non-gate-keeping (optional referral).
- Information asymmetry exists between insurers and GPs regarding diagnosis effort and referral decisions.
Purpose of the Study:
- To compare the effectiveness of gate-keeping versus non-gate-keeping systems.
- To model the relationship between GP diagnostic effort and referral behavior.
- To identify optimal contracts for public insurers considering information asymmetry.
Main Methods:
- Economic modeling of GP behavior.
- Analysis of referral dependence on diagnostic effort.
- Contract theory applied to public insurance.
Main Results:
- Gate-keeping systems demonstrate superiority when GP incentives are a significant factor.
- The model highlights the impact of information asymmetry on referral decisions.
- Optimal contracts can align GP behavior with insurer objectives.
Conclusions:
- Gate-keeping models offer a more effective structure for managing specialist access.
- Incentive design is critical for optimizing GP behavior in healthcare systems.
- Policy implications favor gate-keeping systems where GP engagement is paramount.