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The European Journal of Health Economics
Erschienen in:

03.08.2020 | Original Paper

How French general practitioners respond to declining medical density: a study on prescription practices, with an insight into opioids use

verfasst von: Julien Silhol, Bruno Ventelou, Anna Zaytseva

Erschienen in: The European Journal of Health Economics | Ausgabe 9/2020

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Abstract

Disparities in physicians' geographical distribution lead to highly unequal access to healthcare, which may impact quality of care in both high and low-income countries. This paper uses a 2013–2014 nationally representative survey of French general practitioners (GPs) matched with corresponding administrative data to analyze the effects of practicing in an area with weaker medical density. To avoid the endogeneity issue on physicians' choice of the location, we enriched our variable of interest, practicing in a relatively underserved area, with considering changes in medical density between 2007 and 2013, thus isolating GPs who only recently experienced a density decline (identifying assumption). We find that GPs practicing in underserved areas do shorter consultations and tend to substitute time-consuming procedures with alternatives requiring fewer human resources, especially for pain management. Results are robust to considering only GPs newly exposed to low medical density. Findings suggest a significant impact of supply-side shortages on the mix of healthcare services used to treat patients, and point to a plausible increased use of painkillers, opioids in particular.
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Fußnoten
1
This comparison should be interpreted with caution, since the functioning of the health systems is not similar across countries.
 
2
From 2010 to 2030, population is expected to increase by 9%, and the population aged over 60 by 30%, according to the French national statistical institute (INSEE). Especially due to this ageing population, the proportion of the population with chronic diseases increases too. For instance, from 14,4% in 2011 to 16,0% in 2016 [8].
 
3
Total number of consultations divided by declared working hours; denominator derived from 2013 question on working hours: “During last/a typical week, how much time did you spend on your private GP activities?” adjusted for vacations [21].
 
4
We computed the variance inflation factor (VIF) to test for multicollinearity and interpreted VIF values less than five as presenting no multicollinearity issues.
 
5
In France, private practice GPs are paid based on the fee-for-service system (25 euros per consultation). This regulated-fee results from a negotiation between the government, Social Security and physician representatives. A physician faces a choice: either she accepts regulated-fee remuneration (irrevocable option) or she can charge “with tact and moderation” an excess fee (unregulated fee, can switch to regulated fee afterwards). However, there has been no possibility for new GPs to opt for unregulated fees since 1990.
 
6
These threshold values correspond to 16% and 42% of GPs in our sample.
 
7
No differences found between respondents giving and refusing consent.
 
8
We find a Pearson correlation coefficient between GP density and physical therapists equal to 0.45 in 2013, at health areas level. The correlation coefficient with self-employed nurses density is equal to 0.26, but it doesn’t take into account nurses employed in health centers. Both coefficients are significant at the 5% level.
 
9
As mentioned in the Results section, the introduction of ‘paramedics density’ in the econometric model of paramedics prescription tends to suppress the significance of the GP density indicator. This seems to suggest that, as far as paramedics underutilization is concerned, low GP density is not an issue per se, but only through its strong correlation with paramedics’ spatial distribution. Two effects might take place: either the GP internalizes the shortage of paramedics and prescribes less paramedics visits, or the GP prescribes just as many paramedics visits, but the patients never carry out the visit, so there are no records in the Social Security dataset.
 
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Metadaten
Titel
How French general practitioners respond to declining medical density: a study on prescription practices, with an insight into opioids use
verfasst von
Julien Silhol
Bruno Ventelou
Anna Zaytseva
Publikationsdatum
03.08.2020
Verlag
Springer Berlin Heidelberg
Erschienen in
The European Journal of Health Economics / Ausgabe 9/2020
Print ISSN: 1618-7598
Elektronische ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-020-01222-8

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