GP and Hospital Choice

Choice in the presence of experts: the role of general practitioners in patients’ hospital choice



This paper considers the micro-econometric analysis of patients’ hospital choice for elective medical procedures when their choice set is pre-selected by a general practitioner (GP). It proposes a two-stage choice model that encompasses both, patient and GP level optimization, and it discusses identification. The empirical analysis demonstrates biases and inconsistencies that arise when strategic pre-selection is not properly taken into account. We find that patients defer to GPs when assessing hospital quality and focus on tangible attributes, like hospital amenities; and that GPs, in turn, as patients’ agents present choice options based on quality, but as agents of health authorities also consider their financial implications….

Previous attempts to survey GPs have been frustrated by very low response rates. For example, in the Competition Commission’s (CC) Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust and Poole Hospital NHS Foundation Trust merger inquiry (2013), the important role of GPs in the referral process was recognized, but no strong conclusions could be drawn (para 6.98, Final Report), because out of 1099 GPs in the hospitals’ catchment areas only 36 GPs (associated with 23 GP practices).


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