| Abstract: |
This dissertation consists of empirical essays within the subject of health
economics. There are four essays in applied micro-econometrics and, as data in
Essays 2 and 4 have a panel format, econometric methods for panel data are
applied. Tobit-type models for limited dependent variables are applied in
Essays 3 and 4, Nested logit models for choice of general practitioner (GP)
are applied in Essay 1 and in Essay 2 modeling and estimation procedures
involving latent structural variables are applied. The market for GPs'
services is the recurrent theme, and a common feature of the empirical
modeling and estimation conducted in the essays of this dissertation is that
latent variables play an important role. <p><p> There are several motivations
for studying the market for GPs. GPs play a key role and constitute the
cornerstone of the health care sector in Norway and other countries with a
national health service. The GP is often a patient's first encounter with the
health care sector. In Norway the GP also acts as a “gatekeeper”, and a
referral from the GP is necessary in order to receive specialized care.
Further, decisions made by GPs have a large impact on public spending such as
sick-leave benefits and drug reimbursements. Due to this pivotal role of
general practice, any research providing policy guidance for the sector will
potentially have noticeable welfare effects. <p><p> Studying this market may
also provide advances in terms of enhanced understanding of economic behavior
in general, and within the discipline of health economics in particular.
Arrow's (1963) article describing various imperfections in the market for
medical care is often considered to mark the founding of health economics
(Culyer and Newhouse, 2000). Many of the peculiarities Arrow describes are,
indeed, present in the market for GPs' services. Asymmetric information limits
consumer sovereignty and creates challenges for designing appropriate
contracts and payment mechanisms. Quality of services is diffcult to observe
and quantify, and optimal consumption of health care services is diffcult to
achieve. While the general research questions in health economics are relevant
in the specific context of general practice, the conditions for knowledge
accumulation seem favorable as well. The availability of detailed and
disaggregated panel data enables identification and quantification of the
mechanisms in focus by applying a large variety of modeling and estimation
methods. In addition, one may argue that economic theory is well suited to
model individual behavior and that assumptions of rational decision makers are
more realistic when describing individuals such as GPs than when describing
institutions such as hospitals. Fuchs (2000) describes two related missions of
health economists: providing valuable input into health policy and enhancing
understanding of economic behavior. Both missions motivate research on the
market for GPs. <p><p> Essays 1 and 2 in this dissertation focus mainly on
factors influencing the patients' or consumers' decision to seek the services
of a particular GP, while Essays 3 and 4 focus on factors influencing the GP's
supply decision. The rest of the text proceeds as follows: The next subsection
provides a brief introduction to the topic of this dissertation. Summaries of
the four essays are given in subsection 1.3. Policy implications of the
findings are presented in subsection 1.4. Limitations and ideas for future
research are discussed in subsection 1.5. Complete versions of Essays 1-4
follow in sections 2-5. <p> <p> |