Physician ownership of complementary medical services

Chen, Brian; Gertler, Paul; Yang, Chun‐Yuh

doi:10.1016/j.jpubeco.2016.09.005

Cited by 20 publications

(4 citation statements)

References 32 publications

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“…Iizuka () finds that physicians in vertically integrated clinics prescribe more branded drugs (in order to capture mark‐up) than other physicians. Similarly, Chen, Gertler and Yang () exploit a policy reform in Taiwan that restricted physician ownership of pharmacies. They find that physicians who had to give up ownership of their pharmacy prescribed 7 per cent less drugs.…”

Section: Medical Labour Supplymentioning

confidence: 99%

Medical Labour Supply and the Production of Healthcare

2019

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Medical labour markets are important because of their size and the importance of medical labour in the production of healthcare and in subsequent patient outcomes. We present a summary of important trends in the UK medical labour market, and we review the latest research on factors that determine medical labour supply and the impact of labour on patient outcomes. The topics examined include: the responsiveness of labour supply to changes in wages, regulation and other incentives; factors that determine the wide variation in physician practice and style; and the effect of teams and management quality on patient outcomes. This literature reveals that while labour supply is relatively unresponsive to changes in wages, medical personnel do react strongly to other incentives, even in the short run. This is likely to have consequences for the quality of care provided to patients. We set out a series of unanswered questions in the UK setting, including: the importance of non‐financial incentives in recruiting and retaining medical staff; how individuals can be incentivised to work in particular specialties and regions; and how medical teams can be best organised to improve care.

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Section: Medical Labour Supplymentioning

confidence: 99%

Medical Labour Supply and the Production of Healthcare

2019

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“…For-profit providers may be concerned that these negative judgments, and their overall reputation, can reduce the likelihood of patients returning for subsequent visits, which can affect their bottom line. Prescribing behaviours that arise from these concerns may vary based on the extent to which medicines demanded are harmful or perceived as such and, in the private sector, profitable 4–8. In this paper, we study the effects of patients demanding two different inappropriate medicines, as examples of trade-offs providers might make between risks, profits, and patient satisfaction 6 7 9 10…”

Section: Introductionmentioning

confidence: 99%

Do private providers give patients what they demand, even if it is inappropriate? A randomised study using unannounced standardised patients in Kenya

et al. 2022

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IntroductionLow and varied quality of care has been demonstrated for childhood illnesses in low-income and middle-income countries. Some quality improvement strategies focus on increasing patient engagement; however, evidence suggests that patients demanding medicines can favour the selection of resistant microbial strains in the individual and the community if drugs are inappropriately used. This study examines the effects on quality of care when patients demand different types of inappropriate medicines.MethodsWe conducted an experiment where unannounced standardised patients (SPs), locally recruited individuals trained to simulate a standardised case, present at private clinics. Between 8 March and 28 May 2019, 10 SPs portraying caretakers of a watery diarrhoea childhood case scenario (in absentia) conducted N=200 visits at 200 private, primary care clinics in Kenya. Half of the clinics were randomly assigned to receive an SP demanding amoxicillin (an antibiotic); the other half, an SP demanding albendazole (an antiparasitic drug often used for deworming), with other presenting characteristics the same. We used logistic and linear regression models to assess the effects of demanding these inappropriate medicines on correct and unnecessary case management outcomes.ResultsCompared with 3% among those who did not demand albendazole, the dispensing rate increased significantly to 34% for those who did (adjusted OR 0.06, 95% CI 0.02 to 0.22, p<0.0001). Providers did not give different levels of amoxicillin between those demanding it and those not demanding it (adjusted OR 1.73, 95% CI 0.51 to 5.82). Neither significantly changed any correct management outcomes, such as treatment or referral elsewhere.ConclusionPrivate providers appear to account for both business-driven benefits and individual health impacts when making prescribing decisions. Additional research is needed on provider knowledge and perceptions of profit and individual and community health trade-offs when making prescription decisions after patients demand different types of inappropriate medicines.Trial registration numbersAmerican Economic Association Registry (#AEARCTR-0000217) and Pan African Clinical Trial Registry (#PACTR201502000770329).

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“…1 On the other hand, agrodealers might purposefully under-provide quality (Bold et al, 2017;Ashour et al, 2019). Or they may recommend products that maximize their own profits instead of customer welfare, as has been observed in numerous other sectors (Hubbard, 1998;Inderst and Ottaviani, 2009;Mullainathan, Noeth, and Schoar, 2012;Chen, Gertler, and Yang, 2016;Anagol, Cole, and Sarkar, 2017). These concerns about securing through agrodealers adoption of the right technologies by the right farmers are akin to concerns about the quality of public services provided by the private sector (Hart, Shleifer, and Vishny, 1997).…”

Section: Introductionmentioning

confidence: 99%

Private Input Suppliers as Information Agents for Technology Adoption in Agriculture

Dar,

de Janvry,

Emerick

et al. 2024

American Economic Journal: Applied Economics

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Information frictions limit the adoption of new agricultural technologies in developing countries. Efforts to improve learning involve spreading information from government agents to farmers. We show that when compared to this government approach, informing private input suppliers in India about a new seed variety increases farmer-level adoption by over 50 percent. Suppliers become more proactive in informing potential customers and carrying the new variety. They induce increased adoption by those with higher returns from the technology. Being motivated by expanded sales offers the most likely motive for these results. (JEL D83, L14, L33, O13, O32, Q12, Q16)

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Physician ownership of complementary medical services

Cited by 20 publications

References 32 publications

Medical Labour Supply and the Production of Healthcare

Medical Labour Supply and the Production of Healthcare

Do private providers give patients what they demand, even if it is inappropriate? A randomised study using unannounced standardised patients in Kenya

Private Input Suppliers as Information Agents for Technology Adoption in Agriculture

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