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Competition, gatekeeping, and health care access

机译：竞争，看门和保健访问

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摘要

We study gatekeeping physicians' referrals of patients to specialty care. We derive theoretical results when competition in the physician market intensifies. First, due to competitive pressure, physicians refer patients to specialty care more often. Second, physicians earn more by treating patients themselves, so refer patients to specialty care less often. We assess empirically the overall effect of competition with data from a 2008-2009 Norwegian survey, National Health Insurance Administration, and Statistics Norway. From the data we construct three measures of competition: the number of open primary physician practices with and without population adjustment, and the Herfindahl-Hirschman index. The empirical results suggest that competition has negligible or small positive effects on referrals overall. Our results do not support the policy claim that increasing the number of primary care physicians reduces secondary care.
机译：我们研究看门医师将患者转诊至专科护理。当医师市场竞争加剧时，我们得出理论结果。首先，由于竞争压力，医生会更频繁地为患者转诊至专科护理。其次，医生通过自己治疗患者获得更多收入，因此减少了对患者进行专科治疗的频率。我们使用来自2008-2009挪威调查，国家健康保险局和挪威统计局的数据，从经验上评估竞争的整体效果。根据数据，我们构建了三种竞争衡量标准：有和没有进行人口调整的开放式主治医师实践的数量，以及赫芬达尔·赫希曼指数。实证结果表明，竞争对推荐人的总体影响微乎其微或很小。我们的结果不支持增加初级保健医师人数会减少二级保健的政策主张。

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