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Practice budgets and the patient mix of physicians – The effect of a remuneration system reform on health care utilisation

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  • Schmitz, Hendrik
Abstract
This study analyses the effect of a change in the remuneration system for physicians on the treatment lengths as measured by the number of doctor visits using data from the German Socio-Economic Panel over the period 1995–2002. Specifically, I analyse the introduction of a remuneration cap (so called practice budgets) for physicians who treat publicly insured patients in 1997. I find evidence that the reform of 1997 did not change the extensive margin of doctor visits but strongly affected the intensive margin. The conditional number of doctor visits among publicly insured decreased while it increased among privately insured. This can be seen as evidence that physicians respond to the change in incentives induced by the reform by altering their patient mix.

Suggested Citation

  • Schmitz, Hendrik, 2013. "Practice budgets and the patient mix of physicians – The effect of a remuneration system reform on health care utilisation," Journal of Health Economics, Elsevier, vol. 32(6), pages 1240-1249.
    • Handle: RePEc:eee:jhecon:v:32:y:2013:i:6:p:1240-1249
    DOI: 10.1016/j.jhealeco.2013.09.013
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    Cited by:

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    2. Dirk Göpffarth & Thomas Kopetsch & Hendrik Schmitz, 2016. "Determinants of Regional Variation in Health Expenditures in Germany," Health Economics, John Wiley & Sons, Ltd., vol. 25(7), pages 801-815, July.
    3. Werbeck, Anna & Wübker, Ansgar & Ziebarth, Nicolas R., 2021. "Cream skimming by health care providers and inequality in health care access: Evidence from a randomized field experiment," Journal of Economic Behavior & Organization, Elsevier, vol. 188(C), pages 1325-1350.
    4. Gregori Baetschmann & Rainer Winkelmann, 2014. "A Dynamic Hurdle Model for Zero-Inflated Count Data: With an Application to Health Care Utilization," SOEPpapers on Multidisciplinary Panel Data Research 648, DIW Berlin, The German Socio-Economic Panel (SOEP).
    5. Dimitrova, V.; & Sameen, H.;, 2022. "Static regulation and technological change: Prescribing cost-effective treatments under financial constraints in the English NHS," Health, Econometrics and Data Group (HEDG) Working Papers 22/15, HEDG, c/o Department of Economics, University of York.
    6. Arndt R. Reicher & Magdalena Stroka, 2014. "Nursing Home Prices and Quality of Care - Evidence from Administrative Data," Ruhr Economic Papers 0470, Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Ruhr-Universität Bochum, Universität Dortmund, Universität Duisburg-Essen.
    7. Himmel, Konrad & Schneider, Udo, 2017. "Ambulatory care at the end of a billing period," hche Research Papers 14, University of Hamburg, Hamburg Center for Health Economics (hche).
    8. Braendle, Thomas & Colombier, Carsten, 2020. "Budgetary targets as cost-containment measure in the Swiss healthcare system? Lessons from abroad," Health Policy, Elsevier, vol. 124(6), pages 605-614.
    9. Sylvain Chareyron & Yannick L’Horty & Pascale Petit, 2023. "Cream skimming and discrimination in access to medical care: A field experiment," Health Economics, John Wiley & Sons, Ltd., vol. 32(8), pages 1868-1883, August.
    10. Fonseca Morello, Thiago, 2023. "Hospitalization due to fire-induced pollution in the Brazilian Amazon: A causal inference analysis with an assessment of policy trade-offs," World Development, Elsevier, vol. 161(C).
    11. Carroll, Caitlin & Chernew, Michael & Fendrick, A. Mark & Thompson, Joe & Rose, Sherri, 2018. "Effects of episode-based payment on health care spending and utilization: Evidence from perinatal care in Arkansas," Journal of Health Economics, Elsevier, vol. 61(C), pages 47-62.
    12. Kuhn, Michael & Ochsen, Carsten, 2019. "Population change and the regional distribution of physicians," The Journal of the Economics of Ageing, Elsevier, vol. 14(C).
    13. repec:zbw:rwirep:0470 is not listed on IDEAS
    14. Caitlin Carroll & Michael Chernew & A. Mark Fendrick & Joe Thompson & Sherri Rose, 2017. "Effects of Episode-Based Payment on Health Care Spending and Utilization: Evidence from Perinatal Care in Arkansas," NBER Working Papers 23926, National Bureau of Economic Research, Inc.

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    More about this item

    Keywords

    Reform evaluation; Physician reimbursement; Health care utilisation; Ambulatory care; Practice budgets;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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