Brasure M, Stearns S C, Norton E C, Ricketts T
University of Minnesota, USA.
Med Care Res Rev. 1999 Dec;56(4):395-414. doi: 10.1177/107755879905600401.
Competition often is viewed as a mechanism for controlling cost. Competition may work well in urban areas with many providers; competition may not exist in rural areas with few providers. The authors use the empirical framework developed by Bresnahan and Reiss to analyze the entry behavior of physicians into local markets to determine the level of physician supply consistent with competitive behavior. The study estimates entry patterns for total and specialty physicians located in nonmetropolitan health service areas using longitudinal data. The authors find a surprising drop in the population increments necessary for entry by the second provider, possibly due to the unattractiveness of being the solo physician in an area. Subsequent population increments stabilize at three to five physicians. Since more than 93 percent of the U.S. population lives in areas that can support three to five physicians, competition between physicians through mechanisms such as managed care may be feasible.
竞争通常被视为控制成本的一种机制。在有众多供应商的城市地区，竞争可能会很好地发挥作用；而在供应商较少的农村地区，竞争可能并不存在。作者运用布雷斯纳汉和赖斯开发的实证框架，分析医生进入当地市场的行为，以确定与竞争行为相一致的医生供应水平。该研究使用纵向数据估计了位于非大都市卫生服务区的全科医生和专科医生的进入模式。作者发现，第二位供应商进入所需的人口增量出现了惊人的下降，这可能是由于在一个地区作为唯一的医生缺乏吸引力。随后的人口增量在三到五名医生时趋于稳定。由于超过93%的美国人口生活在能够支持三到五名医生的地区，通过管理式医疗等机制在医生之间展开竞争可能是可行的。
