Patient Mobility, Health Care Quality and Welfare.

Patient mobility is a key issue in the EU who recently passed a new law on patients’right to EU-wide provider choice. In this paper we use a Hotelling model with two regions that differ in technology to study the impact of patient mobility on health care quality, health care financing and welfare. A decentralised solution without patient mobility leads to too low (high) quality and too few (many) patients being treated in the high-skill (low-skill) region. A centralised solution with patient mobility implements the first best, but the low-skill region would not be willing to transfer authority as its welfare is lower than without mobility. In a decentralised solution, the effects of patient mobility depend on the transfer payment. If the payment is below marginal cost, mobility leads to a ‘race-to-the-bottom’in quality and lower welfare in both regions. If the payment is equal to marginal cost, quality and welfare remain unchanged in the high-skill region, but the low-skill region bene…ts. For a socially optimal payment, which is higher than marginal cost, quality levels in the two regions are closer to (but not at) the …rst best, but welfare is lower in the low-skill region. Thus, patient mobility can have adverse effects on quality provision and welfare unless an appropriate transfer payment scheme is implemented.Patient mobility; Health care quality; Regional and global welfare.

Patient mobility, health care quality and welfare

Patient mobility is a key issue in the EU who recently pased a new law on patients`right to EU-wide provider choice. In this paper we use a hotelling model with txo regions that differ in technology to study the impact of patient mobility leads to too low (higt) quality and two few (many) patients being treated in the high-skill (low-skill) region. A centralised solution with patient mobility implements the first best, but the low - skill region would not be willing to trnsfer authority as its welfare is lower than without mobility. In a decentralised solution, the effects of pacient mobility depend on the transfer payment. If the payment is below marginal cost, mobility leads to a "race-to-the-bottom" in quality and lower welfare in both regions. In the payment is equal to marginal cost, quality and welfare remain unchanged in the high-skill region, but the low-skill region benefits. For a socially optimal payment, wich is higher than marginal cost, quality levels in the two regions are closer to (but not at) the first best, but welfare is lower in the low-skill region. Thus, patient mobility can have adverse effects on quality provision and welfare unles an appropriate transfer payment scheme is implemented.Fundação para a Ciência e a Tecnologia (FCT

Patient Mobility and Health Care Quality when Regions and Patients Differ in Income

This paper studies the effects of cross-border patient mobility on health care quality and welfare when income varies across and within regions. We use a Salop model with a high, middle and low income region, where, in each region, a policy maker chooses the level of health care quality that maximises welfare subject to costs being financed by general taxation. In equilibrium, regions with higher income offer better quality, implying that the high (low) income region imports (exports) patients and the middle-income region both imports and exports patients. Assuming DRG-pricing, we find that a reduction in mobility costs has generally heterogeneous effects on regional health care quality and welfare, with low and middle income regions being vulnerable to adverse effects of cross-border health care liberalisation. We also show that higher income inequality in a region might have negative spillover effects on quality provision in other regions because of cross-border patient mobility.COMPETE, QREN, FEDER, FC

Patient Mobility, Health Care Quality and Welfare

Patient mobility is a key issue in the EU who recently pased a new law on patients`right to EU-wide provider choice. In this paper we use a hotelling model with txo regions that differ in technology to study the impact of patient mobility leads to too low (higt) quality and two few (many) patients being treated in the high-skill (low-skill) region. A centralised solution with patient mobility implements the first best, but the low - skill region would not be willing to trnsfer authority as its welfare is lower than without mobility. In a decentralised solution, the effects of pacient mobility depend on the transfer payment. If the payment is below marginal cost, mobility leads to a "race-to-the-bottom" in quality and lower welfare in both regions. In the payment is equal to marginal cost, quality and welfare remain unchanged in the high-skill region, but the low-skill region benefits. For a socially optimal payment, wich is higher than marginal cost, quality levels in the two regions are closer to (but not at) the first best, but welfare is lower in the low-skill region. Thus, patient mobility can have adverse effects on quality provision and welfare unles an appropriate transfer payment scheme is implemented.Patient Mobility, Health Care Quality; Regional an global welfare

The breadth of primary care: a systematic literature review of its core dimensions

Background: Even though there is general agreement that primary care is the linchpin of effective health care delivery, to date no efforts have been made to systematically review the scientific evidence supporting this supposition. The aim of this study was to examine the breadth of primary care by identifying its core dimensions and to assess the evidence for their interrelations and their relevance to outcomes at (primary) health system level. Methods: A systematic review of the primary care literature was carried out, restricted to English language journals reporting original research or systematic reviews. Studies published between 2003 and July 2008 were searched in MEDLINE, Embase, Cochrane Library, CINAHL, King's Fund Database, IDEAS Database, and EconLit. Results: Eighty-five studies were identified. This review was able to provide insight in the complexity of primary care as a multidimensional system, by identifying ten core dimensions that constitute a primary care system. The structure of a primary care system consists of three dimensions: 1. governance; 2. economic conditions; and 3. workforce development. The primary care process is determined by four dimensions: 4. access; 5. continuity of care; 6. coordination of care; and 7. comprehensiveness of care. The outcome of a primary care system includes three dimensions: 8. quality of care; 9. efficiency care; and 10. equity in health. There is a considerable evidence base showing that primary care contributes through its dimensions to overall health system performance and health. Conclusions: A primary care system can be defined and approached as a multidimensional system contributing to overall health system performance and health

Behaviour in therapeutic medical care: evidence from general practitioners in Austria

Aim: The present study examines monetary effects of general practioners’ behaviour in therapeutic medical care to identify sample characteristics that allow differentiating between the individual general practitioner and the basic population. Subjects and methods: Medical services, provided by 3,919 general practitioners in Austria, were operationalized by means of the dependent variable “costs per patient”. Statistical outliers were identified using Chebyshev’s inequality and categorized by investigating bivariate correlations between the dependent variable and the personal characteristics of each physician. Results: Variables that relate to the size of the customer base such as number of consultations (r = 0.385) and office days (r = 0.376), correlate positively with the costs for medical services. By analyzing the portfolio of the general practitioners, we found a correlation of 0.451 between this coefficient and the costs. Statistical outliers feature an average portfolio of 44.5 different services, compared to 30.45 among non-outliers. Laboratory services especially were identified as cost drivers (r = 0.408). Statistical outliers generate at least one laboratory parameter for 44.34% of their patients, opposed to 27.2% within the rest of the sample. Consequently outliers produce higher laboratory costs than their counterparts. Conclusion: We found some evidence that physicians have influence in the provision of their services. Considering entrepreneurial objectives, the extension of the portfolio can increase their profit. Our findings indicate supplier-induced demand for several groups of services. We assume that the effect is consolidated by the fee for service system and could be compensated by adequate reform