Patient choice and access to primary physician services in Norway

Quasi-markets have become fashionable within health care. This is also the case in Norway where primary physician services are organized as a quasi-market. Physicians compete for patients, and patients can choose another physician if they are not satisfied with the physician they have. This is meant to provide incentives for physicians to provide services that are both efficient and of high quality. One condition that is necessary in order for such a market to function is that there is excess supply to ensure that patients have a real opportunity for choice. In this study we investigated the influence of excess supply on patient access and the mobility of patients between primary physicians in Norway. The analyses were performed on data from two comprehensive national surveys. Access to physicians is better for physicians who have spare capacity than for physicians who have a lack of capacity. Patients take advantage of their possibilities for choice. They move from physicians who have too little capacity to physicians who have spare capacity. Patient choice means that patients are not 'stuck' with physicians who have too little capacity to provide adequate services for their patients. The results show that quasi-markets can ensure good access to primary physician services, but this presupposes that there is enough spare capacity to provide patients with a real choice of physician.