Abstract
The study examines how the service production of primary physicians in Norway is influenced by changes in fees. The data represent about 2,650 fee-for-service physicians for the years 1995–2000. We constructed a variable that made it possible to estimate income effects of fee changes on service levels. Service production was measured by the number of consultations per physician, the number of laboratory tests per consultation and the proportion of consultations lasting more than 20 min. Our main finding is that fee changes have no income effect on service production. Our results imply that fee regulation can be an effective means of controlling physicians’ income, and therefore government expenditure, on primary physician services.
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Notes
There are also two other types of primary physician: self-employed physicians and junior physicians. Self-employed physicians are independent and have no contract with the municipality. About 7% of all primary physicians are self-employed, and the majority are located in central cities. Junior physicians are medical students who have completed their studies, but who are not fully registered. They become fully registered after having worked under supervision in a municipality and in a hospital for 1 year. They are mainly located in small municipalities where there are problems recruiting community physicians or contract physicians [22].
The numbers of physicians who were present in two consecutive years (in brackets) were: 896 (1995 and 1996), 545 (1996 and 1997), 375 (1997 and 1998), 334 (1998 and 1999) and 513 (1999 and 2000). The percentage of physicians who were represented in our sample in relation to the total population of contract physicians according to year (in brackets) were: 47% (1995 and 1996), 26% (1996 and 1997), 17% (1997 and 1998), 15% (1998 and 1999) and 22% (1999 and 2000) [22]. The sample size varies each year, according to the amount of resources that the National Insurance Administration decides to use on collecting these data.
The two latter variables were measured at the level of economic regions as these data were not available at the municipal level. There are 89 economic regions in Norway. Within an economic region, a town or a population centre makes up the central point, surrounded by smaller municipalities. The municipalities are grouped according to a naturally occurring trade and commerce structure.
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We wish to thank Linda Grytten for translating the original manuscript to English.
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Grytten, J., Carlsen, F. & Skau, I. Primary physicians’ response to changes in fees. Eur J Health Econ 9, 117–125 (2008). https://doi.org/10.1007/s10198-007-0049-2
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DOI: https://doi.org/10.1007/s10198-007-0049-2