Advertisement

The European Journal of Health Economics

, Volume 8, Issue 3, pp 225–236 | Cite as

Variations in activity and practice patterns: a French study for GPs

  • Sophie Béjean
  • Christine Peyron
  • Renaud Urbinelli
Original paper

Abstract

Objectives

To identify the different practice profiles of general practitioners (GPs) in order to test the hypothesis of heterogeneity in physician behaviour.

Data

For the year 2000, 4,660 GPs from two regions in France. Variables: volume and structure of the physicians’ medical activity, income level, personal characteristics, socioeconomic and geographical environment, characteristics of their patients.

Methods

A cluster analysis to identify different practice profiles and a regression analysis to display the determinants of the physicians’ activity.

Results

Four different homogeneous groups can be identified, each one associating a physician’s level of activity to his socioeconomic status. The level and the intensity of medical activity depend on individual factors, patients’ characteristics as well as the socioeconomic context.

Conclusions

There is no uniformity in the way GPs practice medicine. An immediate consequence is that any cost-containment measure that is applied uniformly to all GPs inevitably results in different outcomes according to the physicians’ category type.

Keywords

Medical activity Practice profiles General practitioner Cluster analysis Hypothesis test 

JEL Classification

I 11 

Notes

Acknowledgements

This research was funded by MiRe-DREES of the French Ministère de l’emploi et de la solidarité. We wish to thank Victor Rodwin and three anonymous referees whose comments made it possible to substantially modify this article. However, we are solely responsible for any imperfections.

References

  1. 1.
    Bejean, S., Peyron, C.: Comportements et activité des médecins libéraux : une approche conventionnaliste. Analyse théorique et empirique. Rapport Mire, convention no. 3/99 (2002)Google Scholar
  2. 2.
    BensinG, J.M., Van Den Brink Muinen, A., De Bakker Dh.: Gender differences in practice style: a Dutch study of general practitioners. Med. Care 31(3), 219–229 (1993)CrossRefGoogle Scholar
  3. 3.
    Carrere, M.O.: The reaction of private physicians to price deregulation in France. Soc. Sci. Med. 33(11), 1221–1128 (1991)CrossRefGoogle Scholar
  4. 4.
    Contandiopoulos AP et al.: Profils de pratique des médecins généralistes du Québec. Rapport R01-10. GRIS:Université de Montréal (2001)Google Scholar
  5. 5.
    Croxson, B., Propper, C., Perkins, A.: Do doctors respond to financial incentives? UK family doctors and the GP fundholder scheme. J. Public Econ. 79, 375–398 (2001)CrossRefGoogle Scholar
  6. 6.
    Damon, M.N., Vincke, B., Duver, S., Thielly, P.: L’analyse multidimensionnelle comme outil de mesure de la diversité de l’offre de soins ambulatoire. Revue Medicale de l’Assurance Maladie 35(2), 91–99 (2004)Google Scholar
  7. 7.
    Darbon, S., Letourmy, A.: Contextes communaux et marché de services de généralistes. Sciences Sociales et Santé 7(2), 91–107 (1989)Google Scholar
  8. 8.
    Davis, P., Gribben, B., Scott, A., Lay-Yee, R.: The << supply hypothesis >> and medical practice variation in primary care: testing economic and clinical models of inter-practitioner variation. Soc. Sci. Med. 50, 407–418 (2000)CrossRefGoogle Scholar
  9. 9.
    Dedobbeleer, N., Contandriopoulos, A.P., Desjardins, S.: Convergence or divergence of male and female physicians’hours of work and income. Med. Care 33(8), 796–805 (1995)CrossRefGoogle Scholar
  10. 10.
    Delattre, E.: Comportements d’offre de soins des médecins français. Thèse de doctorat de science économique, Université de Paris X Nanterre (2000)Google Scholar
  11. 11.
    Delattre E, Dormont B (2000) Induction de la demande de soins par les médecins libéraux français. Etude microéconométrique sur données de panel. Economie et Prévision 142Google Scholar
  12. 12.
    De Pouvourville et al.: La démographie en ophtalmologie 2000–2020. CREGAS, rapport au Conseil Scientifique de la CNAMTS (2003)Google Scholar
  13. 13.
    Desrosieres, A.: La politique des grands nombres. Histoire de la raison statistiques. La Découverte:Paris (2000)Google Scholar
  14. 14.
    Dubec, I., Leconte, E., Ruiz-Gazen, A.: Determinants of physicians’ fees: a Bayesian probit model with spatial dependencies. In: 2nd Spatial Econometrics Workshop, LEG, May 13th, Dijon. (2003)Google Scholar
  15. 15.
    Evans, R.G.: (1974) Supplier-induced demand: some empirical evidence and implications. In: Perlman, M. (ed.) The Economics of Health and Medical Care, Proceedings of a conference held by the International Economic Association, Tokyo, 1973, MacMillan, London, pp. 162–173 Google Scholar
  16. 16.
    Everitt, B.S., Landau, S., Leese, M.: Cluster analysis. New York: Oxford University Press Inc (2001)Google Scholar
  17. 17.
    Groenewegen, P.P., Hutten, J.B.: The influence of supply-related characteristics on general practitioners workload. Soc. Sci. Med. 40(3), 349–358 (1995)CrossRefGoogle Scholar
  18. 18.
    Grytten, J., Carlsen, F., Sorensen, R.: Supplier inducement in a public health care system. J. Health Econ. 14, 207–229 (1995)CrossRefGoogle Scholar
  19. 19.
    Guiffrida, A., Gravelle, H.: Inducing or restraining demand: the market for night visits in primary care. J. Health Econ. 20, 755–779 (2001)CrossRefGoogle Scholar
  20. 20.
    Hellinger, F.: The impact of financial incentives on physician behaviour in managed care plans : a review of the evidence. Med. Care Res. Rev. 53, 294–314 (1996)CrossRefGoogle Scholar
  21. 21.
    Jaye, C., Tilyard, M.: A qualitative comparative investigation of variation in general practitioners’prescribing patterns. Br. J. Gen. Pract. 52(478), 381–386 (2002)Google Scholar
  22. 22.
    Kristiansen, I.S., Mooney, G.: The general practitioner’s use of time: is it influenced by the remuneration system? Soc. Sci. Med. 37(3), 393–399 (1993)CrossRefGoogle Scholar
  23. 23.
    Lancry PJ (1989) Le secteur 2 de la médecine libérale, un élément de marché ? Revue d’Economie Politique 99–6Google Scholar
  24. 24.
    Lancry, P.J., Paris, V.: Age, temps et normes : une analyse de la prescription pharmaceutique. Economie et Prévision 129–130(3–4), 173–188 (1997)Google Scholar
  25. 25.
    Mosse, P.: Induction de la demande et filières. Une étude de cas contextualisée. Journal d’Economie Médicale 13(5), 235–246 (1995)Google Scholar
  26. 26.
    Rochaix, L.: Financial incentives for physicians : the Quebec experience. Health Econ. 2, 163–176 (1993)CrossRefGoogle Scholar
  27. 27.
    Ryan, M.: Agency in health care, lessons for economists from sociologists. Am. J. Econ. Soc. 207–218 (1994)Google Scholar
  28. 28.
    Scott, A., Shiell, A., King, M.: Is general practitioner decision making associated with patient socio-economic status?. Soc Sci. Med. 42(1), 35–46 (1996)CrossRefGoogle Scholar
  29. 29.
    Sloan, F.A.: Is the market for physician services monopolistic or competitive ? Profile of medical practice (American Medical Association, Chicago, Illinois) 67–80 (1979)Google Scholar
  30. 30.
    Sorensen, R., Grytten, J.: Competition and supplier-induced demand in a health care system with fixed fees. Health Econ. 8, 497–508 (1999)CrossRefGoogle Scholar
  31. 31.
    Westert, G.P., Groenewegen, P.P.: Medical practice variations: changing the theoretical approach. Scand. J. Public Health 27(3), 173–180 (1999)CrossRefGoogle Scholar
  32. 32.
    Whynes, D., Baines, D.: Predicting activity and workload in general practice from the demographic structure of the practice population. J. Health Serv. Res. Policy 1(3), 128–134 (1996)Google Scholar
  33. 33.
    Wong, H.S.: Market structure and the role of consumer information in the physician services industry: an empirical test. J. Health Econ. 15, 139–160 (1996)CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Sophie Béjean
    • 1
    • 2
  • Christine Peyron
    • 1
  • Renaud Urbinelli
    • 1
  1. 1.Laboratoire d’Economie et GestionLEG UMR 5118 CNRS-Université de BourgogneBourgogneFrance
  2. 2.Pôle d’Economie et de GestionDijon CedexFrance

Personalised recommendations