An Empirical Analysis of the Effects of GP Competition

Pike, Chris (2010): An Empirical Analysis of the Effects of GP Competition.

Abstract

We analyse the relationship between the quality of a GP practice in England and the degree of competition that it faces (as indicated by the number of nearby rival GP practices). We find that those GP practices that are located close to other rival GP practices provide a higher quality of care than that provided by GP practices that lack competitors. This higher level of quality is observed firstly in an indicator of clinical quality (referrals to secondary care for conditions that are treatable within primary care), and secondly in an indicator of patient observed quality (patient satisfaction scores obtained from the national GP patient survey). The association between increased competition and higher quality is found for GP practices located within 500 metres of each other. However it would appear that the magnitude and geographic scope of the relationship are constrained by restrictions upon patient choice. As a result the findings presented here may only reflect a fraction of the potential benefits to patients from increased choice and competition.

• Item Type: MPRA Paper
• Language: English
• Keywords: General Practice; Primary care; Competition; Quality
• Subjects: I - Health, Education, and Welfare > I1 - Health > I11 - Analysis of Health Care Markets; L - Industrial Organization > L3 - Nonprofit Organizations and Public Enterprise > L32 - Public Enterprises ; Public-Private Enterprises; L - Industrial Organization > L1 - Market Structure, Firm Strategy, and Market Performance

References

Beckert, W and Mazzarotto, N “Price-Concentration Analysis in Merger Cases with Differentiated Products” December 20062006, http://www.competition-commission.org.uk/our_role/analysis/pc_analysis_merger_cases.pdf

Billinghurst, B and Whitfield, M “Why do Patients Change their General Practitioner? A Postal Questionnaire Study of Patients in Avon”, British Journal of General Practice, August 1993

Bloom, N, Propper, C, Seiler, S and Van Reenen, J "The Impact of Competition on Management Quality: Evidence from Public Hospitals" 2010, NBER Working Papers 16032, National Bureau of Economic Research

Cooper, Z, Gibbons, S, Jones, S, and McGuire, A “Does Hospital Competition Save Lives? Evidence from the English NHS Patient Choice Reforms” January 2010, LSE Health Working paper No: 16/2010

Croxson, B, Perkins, A and Propper, C “Do Doctors Respond to Financial Incentives? UK Family Doctors and the GP Fundholder Scheme” Journal of Public Economics, February 2001, Vol.79, No.2, pp375-389

Dixon, A, Le Grand, J, Robertson, R “Patient Choice in General Practice: The Implications of Patient Satisfaction Surveys” Journal of Health Services Research and Policy, Vol.3, No.2

Gaynor, M, Moreno-Serra, R and Propper, C “Death by Market Power: Reform, Competition and Patient Outcomes in the National Health Service”, July 2010, NBER Working Paper No. 16164: http://papers.nber.org/papers/w16164

Gravelle, H, Morris, S, and Sutton, M “Are General Practitioners Good For You? Endogenous Supply and Health”, October 2006, Centre for Health Economics Research Paper 20, University of York.

Gravelle, H, Morris, S, and Sutton, M “Doctor Behaviour Under a Pay for Performance Contract: Treating, Cheating and Case Funding?” February 2010, The Economic Journal, Vol.120, pp129-156

Jenkins, C and Campbell, J “Catchment Areas in General Practice and their Relation to Size and Quality of Practice and Deprivation: A Descriptive Study in a London Borough” British Medical Journal, 1996 Vol.313, pp1189-1192

Luras, H “General Practice: Four Essays on GP Behaviour and Individuals Preferences for GPs”, Working paper 2004:1 University of Oslo Health Economics Research Programme

Salisbury, C “How do People Choose their Doctor?” September 1989, British Medical Journal, Vol.299, pp608-610

Waddams, C and Chang, T “Gain or Pain: Does Consumer Activity Reflect Utility Maximisation?” Centre for Competition Policy, University of East Anglia, Working Paper 08-15 http://www.uea.ac.uk/polopoly_fs/1.104668!ccp08-15.pdf