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Erschienen in: The European Journal of Health Economics 4/2015

01.05.2015 | Original Paper

Gender differences in French GPs’ activity: the contribution of quantile regressions

verfasst von: Magali Dumontet, Carine Franc

Erschienen in: The European Journal of Health Economics | Ausgabe 4/2015

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Abstract

In any fee-for-service system, doctors may be encouraged to increase the number of services (private activity) they provide to receive a higher income. Studying private activity determinants helps to predict doctors’ provision of care. In the context of strong feminization and heterogeneity in general practitioners’ (GP) behavior, we first aim to measure the effects of the determinants of private activity. Second, we study the evolution of these effects along the private activity distribution. Third, we examine the differences between male and female GPs. From an exhaustive database of French GPs working in private practice in 2008, we performed an ordinary least squares (OLS) regression and quantile regressions (QR) on the GPs’ private activity. Among other determinants, we examined the trade-offs within the GPs’ household considering his/her marital status, spousal income, and children. While the OLS results showed that female GPs had less private activity than male GPs (−13 %), the QR results emphasized a private activity gender gap that increased significantly in the upper tail of the distribution. We also find gender differences in the private activity determinants, including family structure, practice characteristics, and case-mix variables. For instance, having a youngest child under 12 years old had a positive effect on the level of private activity for male GPs and a negative effect for female GPs. The results allow us to understand to what extent the supply of care differs between male and female GPs. In the context of strong feminization, this is essential to consider for organizing and forecasting the GPs’ supply of care.
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Fußnoten
1
67 %, according to Eco-Santé, Adeli. The remaining 33 % are salaried GPs practicing at a hospital or nursing home.
 
2
The median percentage of income earned from salaried activities for self-employed GPs who work part time as salaried workers is 10 %. These GPs are more likely to be women, to perform fewer acts, to conduct fewer home visits, and are more likely to be located in rural areas.
 
3
According to a list of illnesses and to coordinate for a referral doctor (médecin traitant).
 
4
Since the implementation of the ‘care pathway’ (2004), patients can consult with the GP they want, but they are required to report to the public insurer through a médecin traitant) who is in charge of coordinating the treatments and allowing access to secondary care (specialists).
 
5
MEP GPs are older, more likely to be women, practice less in rural areas, perform fewer services, and conduct fewer home visits, but they perform more specialized procedures than other GPs.
 
6
Any service provided by such a doctor is not compensated by the public health insurance and also by most complementary health insurance. This group includes 1.15 % of GPs.
 
7
We did not use the logarithm of the total number of services because the total number of services was better adjusted with a normal distribution.
 
8
We measure age in deviations from the age of 30 years.
 
9
Civil partnership corresponds to the civil solidarity pact, commonly known as a PACS, which is a form of civil union between two adults (same sex or opposite sex). The PACS was approved by the French Parliament in November 1999.
 
10
The elasticity calculation was \(- 0.027 = - 0.007\,*\,\frac{20811.94}{5329}\) for men and \(- 0.031 = - 0.002*\frac{61300.84}{3908}\) for women.
 
11
For female GPs, the difference between the coefficient for having a youngest child under 12 years of age and having a youngest child over 12 years old was significant (p < 0.05), whereas for male GPs, the difference was not significant.
 
Literatur
1.
Zurück zum Zitat OECD: Health at a Glance 2013: OECD Indicators (2013) OECD: Health at a Glance 2013: OECD Indicators (2013)
2.
Zurück zum Zitat CNOM: Atlas de la démographie médicale (2011) CNOM: Atlas de la démographie médicale (2011)
3.
Zurück zum Zitat Jovic, E., Wallace, J.E., Lemaire, J.: The generation and gender shifts in medicine: an exploratory survey of internal medicine physicians. BMC Health Serv. Res. 6, 55 (2006)CrossRefPubMedCentralPubMed Jovic, E., Wallace, J.E., Lemaire, J.: The generation and gender shifts in medicine: an exploratory survey of internal medicine physicians. BMC Health Serv. Res. 6, 55 (2006)CrossRefPubMedCentralPubMed
4.
Zurück zum Zitat Davis, P., Gribben, B., Scott, A., Lay-Yee, R.: The “supply hypothesis” and medical practice variation in primary care: testing economic and clinical models of inter-practitioner variation. Soc. Sci. Med. 1982(50), 407–418 (2000)CrossRef Davis, P., Gribben, B., Scott, A., Lay-Yee, R.: The “supply hypothesis” and medical practice variation in primary care: testing economic and clinical models of inter-practitioner variation. Soc. Sci. Med. 1982(50), 407–418 (2000)CrossRef
5.
Zurück zum Zitat Groenewegen, P.P., Hutten, J.B.: The influence of supply-related characteristics on general practitioners’ workload. Soc. Sci. Med. 1982(40), 349–358 (1995)CrossRef Groenewegen, P.P., Hutten, J.B.: The influence of supply-related characteristics on general practitioners’ workload. Soc. Sci. Med. 1982(40), 349–358 (1995)CrossRef
6.
Zurück zum Zitat Jaye, C., Tilyard, M.: A qualitative comparative investigation of variation in general practitioners’ prescribing patterns. Br. J. Gen. Pract. 52, 381–386 (2002)PubMedCentralPubMed Jaye, C., Tilyard, M.: A qualitative comparative investigation of variation in general practitioners’ prescribing patterns. Br. J. Gen. Pract. 52, 381–386 (2002)PubMedCentralPubMed
7.
Zurück zum Zitat Boerma, W.G., van den Brink-Muinen, A.: Gender-related differences in the organization and provision of services among general practitioners in Europe: a signal to health care planners. Med. Care 38, 993–1002 (2000)CrossRefPubMed Boerma, W.G., van den Brink-Muinen, A.: Gender-related differences in the organization and provision of services among general practitioners in Europe: a signal to health care planners. Med. Care 38, 993–1002 (2000)CrossRefPubMed
8.
Zurück zum Zitat Constant, A., Léger, P.T.: Estimating differences between male and female physician service provision using panel data. Health Econ. 17, 1295–1315 (2008)CrossRefPubMed Constant, A., Léger, P.T.: Estimating differences between male and female physician service provision using panel data. Health Econ. 17, 1295–1315 (2008)CrossRefPubMed
9.
Zurück zum Zitat Fauvet, L., Romain, O., Buisine, S., Laurent, P.: Les affectations des étudiants en médecine à l’issue des épreuves classantes nationales en 2011. Etudes Résultats (2012) Fauvet, L., Romain, O., Buisine, S., Laurent, P.: Les affectations des étudiants en médecine à l’issue des épreuves classantes nationales en 2011. Etudes Résultats (2012)
10.
Zurück zum Zitat Bensing, J.M., van den Brink-Muinen, A., de Bakker, D.H.: Gender differences in practice style: a Dutch study of general practitioners. Med. Care 31, 219–229 (1993)CrossRefPubMed Bensing, J.M., van den Brink-Muinen, A., de Bakker, D.H.: Gender differences in practice style: a Dutch study of general practitioners. Med. Care 31, 219–229 (1993)CrossRefPubMed
11.
Zurück zum Zitat Breuil-Genier, P., Gofette, C.: La durée des séances des médecins généralistes. Etudes Résultats (2006) Breuil-Genier, P., Gofette, C.: La durée des séances des médecins généralistes. Etudes Résultats (2006)
12.
Zurück zum Zitat Béjean, S., Peyron, C., Urbinelli, R.: Variations in activity and practice patterns: a French study for GPs. Eur. J. Health Econ. 8, 225–236 (2007)CrossRefPubMed Béjean, S., Peyron, C., Urbinelli, R.: Variations in activity and practice patterns: a French study for GPs. Eur. J. Health Econ. 8, 225–236 (2007)CrossRefPubMed
13.
Zurück zum Zitat Dedobbeleer, N., Contandriopoulos, A.P., Desjardins, S.: Convergence or divergence of male and female physicians’ hours of work and income. Med. Care 33, 796–805 (1995)CrossRefPubMed Dedobbeleer, N., Contandriopoulos, A.P., Desjardins, S.: Convergence or divergence of male and female physicians’ hours of work and income. Med. Care 33, 796–805 (1995)CrossRefPubMed
14.
Zurück zum Zitat Samson, A.-L., Delattre, E.: Stratégies de localisation des médecins généralistes français: mécanismes économiques ou hédonistes? Econ. Stat. 455, 115–142 (2012) Samson, A.-L., Delattre, E.: Stratégies de localisation des médecins généralistes français: mécanismes économiques ou hédonistes? Econ. Stat. 455, 115–142 (2012)
15.
Zurück zum Zitat Samson, A.-L.: La dispersion des honoraires des omnipraticiens sur la période 1983–2004: une application de la méthode des régressions quantiles. Sér. Etudes. (2006) Samson, A.-L.: La dispersion des honoraires des omnipraticiens sur la période 1983–2004: une application de la méthode des régressions quantiles. Sér. Etudes. (2006)
16.
Zurück zum Zitat Samson, A.-L.: Do French low-income GPs choose to work less? Health Econ. 20, 1110–1125 (2011)CrossRefPubMed Samson, A.-L.: Do French low-income GPs choose to work less? Health Econ. 20, 1110–1125 (2011)CrossRefPubMed
17.
Zurück zum Zitat Koenker, R., Bassett, G.: Regression quantiles. Econometrica 46, 33 (1978)CrossRef Koenker, R., Bassett, G.: Regression quantiles. Econometrica 46, 33 (1978)CrossRef
18.
Zurück zum Zitat Koenker, R., Hallock, K.F.: Quantile regression. J. Econ. Perspect. 15, 143–156 (2001)CrossRef Koenker, R., Hallock, K.F.: Quantile regression. J. Econ. Perspect. 15, 143–156 (2001)CrossRef
19.
Zurück zum Zitat Buchinsky, M.: Recent advances in quantile regression models: a practical guideline for empirical research. J. Hum. Resour. 33, 88 (1998)CrossRef Buchinsky, M.: Recent advances in quantile regression models: a practical guideline for empirical research. J. Hum. Resour. 33, 88 (1998)CrossRef
20.
Zurück zum Zitat Dormont, B., Samson, A.-L.: Medical demography and intergenerational inequalities in general practitioners’ earnings. Health Econ. 17, 1037–1055 (2008)CrossRefPubMed Dormont, B., Samson, A.-L.: Medical demography and intergenerational inequalities in general practitioners’ earnings. Health Econ. 17, 1037–1055 (2008)CrossRefPubMed
21.
Zurück zum Zitat Kehrer, B.H.: Factors affecting the incomes of men and women physicians: an exploratory analysis. J. Hum. Resour. 11, 526 (1976)CrossRefPubMed Kehrer, B.H.: Factors affecting the incomes of men and women physicians: an exploratory analysis. J. Hum. Resour. 11, 526 (1976)CrossRefPubMed
22.
Zurück zum Zitat Wang, C., Sweetman, A.: Gender, family status and physician labour supply. Soc. Sci. Med. 94, 17-25 (2013) Wang, C., Sweetman, A.: Gender, family status and physician labour supply. Soc. Sci. Med. 94, 17-25 (2013)
23.
Zurück zum Zitat Sasser, A.C.: Gender differences in physician pay: tradeoffs between career and family. J. Hum. Resour. 40, 447–504 (2005) Sasser, A.C.: Gender differences in physician pay: tradeoffs between career and family. J. Hum. Resour. 40, 447–504 (2005)
24.
Zurück zum Zitat Rizzo, J.A., Blumenthal, D.: Physician labor supply: do income effects matter? J. Health Econ. 13, 433–453 (1994)CrossRefPubMed Rizzo, J.A., Blumenthal, D.: Physician labor supply: do income effects matter? J. Health Econ. 13, 433–453 (1994)CrossRefPubMed
25.
Zurück zum Zitat Bertrand, M., Goldin, C., Katz, L.F.: Dynamics of the gender gap for young professionals in the financial and corporate sectors. Am. Econ. J. Appl. Econ. 2, 228–255 (2010)CrossRef Bertrand, M., Goldin, C., Katz, L.F.: Dynamics of the gender gap for young professionals in the financial and corporate sectors. Am. Econ. J. Appl. Econ. 2, 228–255 (2010)CrossRef
26.
Zurück zum Zitat Glauber, R.: Race and gender in families and at work the fatherhood wage premium. Gend. Soc. 22, 8–30 (2008)CrossRef Glauber, R.: Race and gender in families and at work the fatherhood wage premium. Gend. Soc. 22, 8–30 (2008)CrossRef
27.
Zurück zum Zitat RERS: Repères et références statistiques sur les enseignements, la formation et la recherche, French Ministry of Education 1, 83–84 (2013) RERS: Repères et références statistiques sur les enseignements, la formation et la recherche, French Ministry of Education 1, 83–84 (2013)
28.
Zurück zum Zitat Clerc, I., L’haridon, O., Paraponaris, A., Protopopescu, C., Ventelou, B.: Fee-for-service payments and consultation length in general practice: a work–leisure trade-off model for French GPs. Appl. Econ. 44, 3323–3337 (2012)CrossRef Clerc, I., L’haridon, O., Paraponaris, A., Protopopescu, C., Ventelou, B.: Fee-for-service payments and consultation length in general practice: a work–leisure trade-off model for French GPs. Appl. Econ. 44, 3323–3337 (2012)CrossRef
29.
Zurück zum Zitat Dumontet, M., Le Vaillant, M., Franc, C.: What determines the income gap between French male and female GPs - the role of medical practices. BMC Fam. Pract. 13, 94 (2012)CrossRefPubMedCentralPubMed Dumontet, M., Le Vaillant, M., Franc, C.: What determines the income gap between French male and female GPs - the role of medical practices. BMC Fam. Pract. 13, 94 (2012)CrossRefPubMedCentralPubMed
30.
Zurück zum Zitat Ventelou, B., Paraponaris, A., Sebbah, R., Aulagnier, M., Protopopescu, C., Gourheux, J.-C., Verger, P.: Un observatoire des pratiques en médecine générale: l’expérience menée en région Provence-Alpes-Côte-d’Azur. Rev. Fr. Aff. Soc. 1, 127–160 (2005) Ventelou, B., Paraponaris, A., Sebbah, R., Aulagnier, M., Protopopescu, C., Gourheux, J.-C., Verger, P.: Un observatoire des pratiques en médecine générale: l’expérience menée en région Provence-Alpes-Côte-d’Azur. Rev. Fr. Aff. Soc. 1, 127–160 (2005)
31.
Zurück zum Zitat Gravelle, H., Hole, A.R., Santos, R.: Measuring and testing for gender discrimination in physician pay: English family doctors. J. Health Econ. 30, 660–674 (2011)CrossRefPubMed Gravelle, H., Hole, A.R., Santos, R.: Measuring and testing for gender discrimination in physician pay: English family doctors. J. Health Econ. 30, 660–674 (2011)CrossRefPubMed
32.
Zurück zum Zitat Firpo, S., Fortin, N.M., Lemieux, T.: Unconditional quantile regressions. Econometrica 77, 953–973 (2009)CrossRef Firpo, S., Fortin, N.M., Lemieux, T.: Unconditional quantile regressions. Econometrica 77, 953–973 (2009)CrossRef
Metadaten
Titel
Gender differences in French GPs’ activity: the contribution of quantile regressions
verfasst von
Magali Dumontet
Carine Franc
Publikationsdatum
01.05.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
The European Journal of Health Economics / Ausgabe 4/2015
Print ISSN: 1618-7598
Elektronische ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-014-0582-8

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