Statement of funding: this study was financially supported by the Dutch Ministry of Health.
MORAL HAZARD AND SUPPLIER-INDUCED DEMAND: EMPIRICAL EVIDENCE IN GENERAL PRACTICE†
Version of Record online: 20 FEB 2012
Copyright © 2012 John Wiley & Sons, Ltd.
Volume 22, Issue 3, pages 340–352, March 2013
How to Cite
van Dijk, C. E., van den Berg, B., Verheij, R. A., Spreeuwenberg, P., Groenewegen, P. P. and de Bakker, D. H. (2013), MORAL HAZARD AND SUPPLIER-INDUCED DEMAND: EMPIRICAL EVIDENCE IN GENERAL PRACTICE. Health Econ., 22: 340–352. doi: 10.1002/hec.2801
Supporting information may be found in the online version of this article.
- Issue online: 5 FEB 2013
- Version of Record online: 20 FEB 2012
- Manuscript Accepted: 10 JAN 2012
- Manuscript Revised: 5 JAN 2012
- Manuscript Received: 20 AUG 2010
- supplier-induced demand;
- moral hazard;
- general practice;
- remuneration system;
- cost sharing;
- managed competition;
- panel data;
- the Netherlands
Changes in cost sharing and remuneration system in the Netherlands in 2006 led to clear changes in financial incentives faced by both consumers and general practitioner (GPs). For privately insured consumers, cost sharing was abolished, whereas those socially insured never faced cost sharing. The separate remuneration systems for socially insured consumers (capitation) and privately insured consumers (fee-for-service) changed to a combined system of capitation and fee-for-service for both groups. Our first hypothesis was that privately insured consumers had a higher increase in patient-initiated GP contact rates compared with socially insured consumers. Our second hypothesis was that socially insured consumers had a higher increase in physician-initiated contact rates. Data were used from electronic medical records from 32 GP-practices and 35 336 consumers in 2005–2007. A difference-in-differences approach was applied to study the effect of changes in cost sharing and remuneration system on contact rates. Abolition of cost sharing led to a higher increase in patient-initiated utilisation for privately insured consumers in persons aged 65 and older. Introduction of fee-for-service for socially insured consumers led to a higher increase in physician-initiated utilisation. This was most apparent in persons aged 25 to 54. Differences in the trend in physician-initiated utilisation point to an effect of supplier-induced demand. Differences in patient-initiated utilisation indicate limited evidence for moral hazard. Copyright © 2012 John Wiley & Sons, Ltd.