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The European Journal of Health Economics

Published in:

01-12-2017 | Original Paper

Gender-specific practice styles and ambulatory health care expenditures

Author: Boris Kaiser

Published in: The European Journal of Health Economics | Issue 9/2017

Abstract

This paper explores the role of physician gender in the expenditures for ambulatory care as a potential source of practice style variation. We exploit a large doctor–patient panel dataset based on insurance-claims data from Switzerland to estimate the effect of physician gender on health care expenditures. We find considerable heterogeneity across specialties. In primary care, female doctors are found to produce similar overall expenditures per visit as their male colleagues, but significantly smaller prescribing costs and significantly higher laboratory costs. In secondary-care specialties, we find that women generate lower overall expenditures, which is mainly driven by consultation costs. These findings provide evidence for the existence of sex-specific practice styles that translate into different overall expenditures as well as different compositions of these expenditures.

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For illustration, only 0.8% of all practices are group practices that offer services in several specialties.

As of 2011, the two previous specialty titles “general medicine” and “internal medicine” were merged to the specialty title “general internal medicine”.

The conversion factor is the same for all ambulatory medial services. However, the conversion factor is determined on the canton level. Throughout the analysis, we adjust for differences in the conversion factor to improve comparability across geographic regions.

For more information on government regulation and price setting, see http://www.bag.admin.ch/themen/krankenversicherung/00263/00264/06695/index.html?lang=de, Swiss Federal Office of Public Health.

Mandatory health insurance also covers a comprehensive basket of pharmaceuticals, inpatient care, physiotherapy and long-term care. By contrast, dental care is not included.

Some rules and cost-sharing features are different for children.

Note that our model can be interpreted as a hierarchical random-effects (RE) framework in which the composite error may be written as \(v_{ip}=a_i+u_{ip}\), where the variable \(a_i\) captures unobserved physician-specific heterogeneity [18].

See http://www.bag.admin.ch/themen/berufe/00411/index.html?lang=de (in German).

We only include specialties in the analysis where samples contain at least 100 physicians of each sex.

We cannot use overall HCE per patient because this would require controlling for the number of visits, which represents a potentially endogenous covariate.

To be precise, \(E[\ln y^1]-E[\ln y^0]\) is the approximate percentage difference in the geometric means of \(y^1\) and \(y^0\).

Note that prescribing costs also include take-home medical devices and items. These are e.g. injections, insulin pumps, waking frames, hearing aids, prostheses, bandages, supports etc. This cost category only constitutes 3.8% of overall prescribing costs, while the rest is attributable to pharmaceutical products.

The PCGs are binary indicators equal to unity if a patient’s annual consumption of a certain drug action exceeds a pre-defined threshold. The variables are calculated from health care data of the previous year to avoid issues of simultaneity. The drug actions and the thresholds are not disclosed to the researcher and are only known to the insurer. Hence, further information on these variables cannot be provided.

We have no information on hours worked. However, since the outcome of interest is expressed in terms of per visit, we do not consider part-time status to be a relevant confounder.

GPs may hold one of three speciality titles which differ somewhat with respect to the length and type of training.

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Title: Gender-specific practice styles and ambulatory health care expenditures
Author: Boris Kaiser
Publication date: 01-12-2017
Publisher: Springer Berlin Heidelberg
Published in: The European Journal of Health Economics / Issue 9/2017
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI: https://doi.org/10.1007/s10198-016-0861-7

At a glance: The STEP trials

Springer Medicine

Gender-specific practice styles and ambulatory health care expenditures

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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