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Supplier-Induced Demand

Reconsidering the Theories and New Australian Evidence

Applied Health Economics and Health Policy volume 5, pages 87–98 (2006)Cite this article

Abstract

This paper reconsiders the evidence and several of the key arguments associated with the theory of supplier-induced demand (SID). It proposes a new theory to explain how ethical behaviour is consistent with SID.

The purpose of a theory of demand and one criterion for the evaluation of a theory is the provision of a plausible explanation for the observed variability in service use. We argue that Australian data are not easily explained by orthodox possible explanation. We also argue that, having revisited the theory of SID, the agency relationship between doctors and patients arises not simply because of asymmetrical information but from an asymmetrical ability and willingness to exercise judgement in the face of uncertainty. It is also argued that the incomplete demand shift that must occur following an increase in the doctor supply is readily explained by the dynamics of market adjustment when market information is incomplete and there is non-collusive professional (and ethical) behaviour by doctors. Empirical evidence of SID from six Australian data sets is presented and discussed. It is argued that these are more easily explained by SID than by conventional demand side variables. We conclude that once the uncertainty of medical decision making and the complexity of medical judgements are taken into account, SID is a more plausible theory of patient and doctor behaviour than the orthodox model of demand and supply. More importantly, SID provides a satisfactory explanation of the observed pattern and change in the demand for Australian medical services, which are not easily explained in the absence of SID.

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Table I

References

  1. Dranove D. Demand inducement and the physician/patient relationship. Econ Inq 1988; 26(2): 281–98

    Article  PubMed  CAS  Google Scholar 

  2. Folland S, Goodman AC, Stano M. The economics of health and health care. New York: MacMillan, 1993

    Google Scholar 

  3. Rice T, Labelle RJ. Do physicians induce demand for medical services? J Health Polit Policy Law 1989; 14(3): 587–600

    Article  PubMed  CAS  Google Scholar 

  4. Donaldson C, Gerrard K. Paying general practitioners: shedding light on the review of health services. J R Coll Gen Pract 1989; 39: 114–7

    PubMed  CAS  Google Scholar 

  5. Fuchs V. The supply of surgeons and the demand for operations. J Hum Resour 1978; 13 Suppl.: 35–56

    Google Scholar 

  6. Fuchs VR, Kramer MJ. Determinants of expenditures for physicians’ services in the United States, 1948–68. National Bureau of Economic Research Occasional Paper no. 117, DHEW Publication (HSM), National Center for Health Services Research and Development. New York: National Bureau of Economic Research, 1972

    Google Scholar 

  7. Richardson J. The inducement hypothesis: that doctors generate demand for their own services. In: van der Gaag J, Perlman M, editors. Health, economics and health economics. Amsterdam: North-Holland Publishing Co., 1981: 189–214

    Google Scholar 

  8. Cromwell J, Mitchell JB. Physician-induced demand for surgery. J Health Econ 1986; 5: 293–313

    Article  PubMed  CAS  Google Scholar 

  9. Phelps C. Induced demand: can we ever know its extent? J Health Econ 1986; 5: 355–65

    Article  PubMed  CAS  Google Scholar 

  10. Evans RG. Supplier-induced demand: some empirical evidence and implications. In: Perlman M, editor. The economics of health and medical care. New York: John Wiley and Sons, 1974

    Google Scholar 

  11. Auster R, Oaxaca R. Identification of supplier induced demand in health care sector. J Hum Resour 1981; 16: 327–42

    Article  PubMed  CAS  Google Scholar 

  12. McGuire TG. Physician agency. In: Culyer AJ, Newhouse JP, editors. Handbook of health economics. Vol. la. Amsterdam: North-Holland, 2000: 461–536

    Chapter  Google Scholar 

  13. Friedson E. Patients’ views of medical practice. New York: Sage, 1961

    Google Scholar 

  14. Siminoff LA, Step MM. A communication model of shared decision making: accounting for cancer treatment decisions. Health Psychol 2005; 24(4): S99–S105

    Article  PubMed  Google Scholar 

  15. Kahneman D, Tversky A. The framing of decisions and the psychology of choice. Science 1981; 211: 453–8

    Article  PubMed  Google Scholar 

  16. Feldman-Stewart D, Brundage MD, McConnell BA, et al. Practical issues in assisting shared decision-making. Health Expect 2000; 3: 46–54

    Article  PubMed  Google Scholar 

  17. Ravdin PM, Siminoff LA, Harvey JA. Survey of breast cancer patients concerning their knowledge and expectations of adjuvant therapy. J Clin Oncol 1998; 16: 515–21

    PubMed  CAS  Google Scholar 

  18. Maynard A, Bloor K. Our certain fate: rationing in health care. London: Office of Health Economics, 1998

    Google Scholar 

  19. Mooney G, Russell E, Weir R. Choices for health care: a practical introduction to the economics of health provision. London: Macmillan, 1986

  20. Hurley J, Birch S, Stoddart G, et al. Medical necessity, benefit and resource allocation in health care. J Health Serv Res Policy 1997; 2: 223–30

    PubMed  CAS  Google Scholar 

  21. Wennberg J. Improving the medical decision making process. Health Aff 1988; 7: 99–106

    Article  CAS  Google Scholar 

  22. Oxley H, MacFarlan M. Health care reform: controlling spending and increasing efficiency. Economics Department working paper no. 149. Paris: OECD, 1994

    Book  Google Scholar 

  23. Richardson J, Peacock S. Supplier induced demand reconsidered. Working paper no. 81. Melbourne (VIC): Centre for Health Program Evaluation, Monash University, 1999

    Google Scholar 

  24. Richardson J. The health care financing debate. In: Mooney G, Scotton RB, editors. Economics and Australian health policy. Sydney (NSW): Allen & Unwin, 1998: 192–213

    Google Scholar 

  25. Richardson J, Deeble J. Statistics of private medical services in Australia 1976. Canberra (ACT): Australian National University Printing Service, 1982. Health Research Project, Technical paper no. 1

    Google Scholar 

  26. Richardson J. Supply and demand for medical care: or, is the health care market perverse? Aust Econ Rev 2001; 34(3): 336–52

    Article  Google Scholar 

  27. Commonwealth Department of Health and Family Services. Medicare statistics: 1984/85 to March quarter 1998. Canberra (ACT): Commonwealth Department of Health and Family Services, 1998

    Google Scholar 

  28. Australian Government Productivity Commission. Australia’s health workforce: Productivity Commission research report. Canberra: Australian Government Productivity Commission, 2005 Dec 22 [online]. Available from URL: http://www.pc.gov.au/study/healthworkforce/finalreport/healthworkforce.pdf [Accessed 2006 May 9]

    Google Scholar 

  29. Scotton R. The doctor business. In: Mooney G, Scotton RB, editors. Economics and Australian health policy. Sydney (NSW): Allen & Unwin, 1998: 72–92

    Google Scholar 

  30. Doessel DP. Is an increased medical workforce a “problem” in the health sector? Theory and evidence. In: Harris A, editor. Economics and Health 1997: proceedings of the Nineteenth Australian Conference of Health Economists. Kensington (NSW): School of Health Services Management, University of New South Wales, 1998: 99–130. Australian Studies in Health Services Administration Series no. 85

    Google Scholar 

  31. Ramsey JB, Wassow B. Supplier induced demand for physician services: theoretical anomaly or statistical artefact? An econometric evaluation of some important models in physician service markets. In: Basmann R, Rhodes G, editors. Advances in econometrics. Greenwich: JAI Press, 1986: 49–77

    Google Scholar 

  32. Robertson I, Richardson J. The effect of funding upon hospital treatment: the case of coronary angiography and coronary artery revascularisation procedures following acute myocardial infarction. Med J Aust 2000; 173: 291–5

    PubMed  CAS  Google Scholar 

  33. Australian Bureau of Statistics (ABS). Australian Standard Geographical Classification (ASGC) 1999. Canberra (ACT): Australian Bureau of Statistics, 1999

    Google Scholar 

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Acknowledgements

The authors would like to thank the Commonwealth Department of Health and Ageing and the Victorian Department of Human Services for the data used in the empirical studies, and two anonymous referees for their comments on an earlier draft of the paper. The research was supported by a National Health and Medical Research Council (NHMRC) Project Grant. The views expressed in this paper are those of the authors, and not the funding agency.

This paper is a revised version of a working paper (Richardson J, Peacock S. Supplier induced demand reconsidered. Working paper no. 81. Melbourne (VIC): Centre for Health Program Evaluation, Monash University, 1999).

Author information

Authors and Affiliations

  1. Centre for Health Economics, Monash University, Clayton, Building 75, VIC, 3800, Australia

    Jeffrey R. J. Richardson

  2. British Columbia Cancer Agency, Vancouver, British Columbia, Canada

    Stuart J. Peacock

  3. Department of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia, Canada

    Stuart J. Peacock

Authors
  1. Jeffrey R. J. Richardson
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  2. Stuart J. Peacock
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Corresponding author

Correspondence to Jeffrey R. J. Richardson.

Appendix

Appendix

1. Small Area Definitions

Small area data used in empirical analysis are based on the hierarchical structure of the Australian Standard Geographical Classification.[33] In noncensus years the classification consists of statistical local areas (SLAs), statistical subdivisions (SSDs), statistical divisions (SDs) and states/territories. Under the hierarchical structure, SLAs are aggregated to form SSDs, SSDs are aggregated to form SDs, and SDs aggregate into states and territories. These spatial units cover all of Australia without gaps or overlaps. As at 1999, there were 1331 SLAs, 194 SSDs and 66 SDs covering mainland and offshore Australian states and territories. SLAs and SSDs are based on defining regions that show social and economic homogeneity through identifiable links between inhabitants, and on local government boundaries. SDs also maintain this basis but, in addition, the capital city of each state/territory is defined as a single SD.

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Richardson, J.R.J., Peacock, S.J. Supplier-Induced Demand. Appl Health Econ Health Policy 5, 87–98 (2006). https://doi.org/10.2165/00148365-200605020-00003

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Keywords

  • Unethical Behaviour
  • Demand Equation
  • Australian Data
  • Medical Market
  • Geographic Availability