Grytten J, Sørensen R
Dental School, University of Oslo, Oslo, Norway.
Health Econ. 2000 Jul;9(5):447-61. doi: 10.1002/1099-1050(200007)9:5<447::aid-hec529>3.0.co;2-a.
Dental services for adults are different from all other Norwegian health services in that they are provided by private producers (dentists) who have full freedom to establish a practice. They have had this freedom since the end of World War II. A further liberalization of the market for dental services occurred in November 1995, when the so-called normal tariff was repealed. The system changed from a fixed fee system to a deregulated fee system. In principle, the market for dental services for adults operates as a free competitive market, in which dentists must compete for a market share. The aim of this study was to study the short-term effects of competition. A comprehensive set of data on fees, practice characteristics, treatment profiles and factors that dentists take into account when determining fees was analysed. The main finding was that competition has a weak effect. No support was found for the theory that the level of fees is the result of monopolistic competition or monopoly. The results also provided some evidence against the inducement hypothesis. At this stage, it is interesting to notice that dentists do not seem to exploit the power they have to control the market. One explanation, which is consistent with the more recent literature, is that physicians' behaviour to a large extent is influenced by professional norms and caring concerns about their patients. Financial incentives are important, but these incentives are constrained by norms other than self-interest. The interpretation of the results should also take into account that the deregulation has operated for a short time and that dentists and patients may not yet have adjusted to changes in the characteristics of the market.
成人牙科服务与挪威所有其他医疗服务不同，因为它由私人提供者（牙医）提供，这些牙医在开设诊所方面拥有完全的自由。自第二次世界大战结束以来，他们就享有这种自由。1995年11月，牙科服务市场进一步自由化，当时所谓的正常收费标准被废除。该体系从固定收费制转变为放松管制的收费制。原则上，成人牙科服务市场作为一个自由竞争市场运作，牙医必须为市场份额展开竞争。本研究的目的是研究竞争的短期影响。分析了一套关于费用、诊所特征、治疗情况以及牙医在确定费用时考虑的因素的综合数据。主要发现是竞争的影响较弱。没有证据支持费用水平是垄断竞争或垄断结果的理论。研究结果也提供了一些反对诱导假设的证据。在这个阶段，有趣的是牙医似乎并未利用他们所拥有的控制市场的权力。一种与近期文献一致的解释是，医生的行为在很大程度上受到专业规范以及对患者的关怀关注的影响。经济激励很重要，但这些激励受到除自身利益之外的规范的约束。对结果的解释还应考虑到放松管制实施的时间较短，而且牙医和患者可能尚未适应市场特征的变化。
