The "supply hypothesis" and medical practice variation in primary care: testing economic and clinical models of inter-practitioner variation

Davis, PeterGribben, BMScott, AJLay Yee, Roy2012-03-272013-12-172015-08-312000Social Science and Medicine, 2000, 50 (3), pp. 407 - 418 (12)0277-9536http://hdl.handle.net/2292/26860Medical practice variation (MPV) is marked, apparently ubiquitous across the health sector, well documented, and continues to be a focus of professional and policy interest. MPV have stimulated two paths of investigation, one economic in emphasis and the other more clinical in orientation; while health economists have stressed the potential role of income incentives in medical decision-making, health services research has tended to emphasise clinical ambiguity as a factor in practitioner decisions. Both sets of explanations converge in an implicit “supply hypothesis” that posits contextual practitioner and practice attributes as influential in clinical decisions. Data on inter-practitioner variation are taken from a large and representative regional survey of general practitioners in New Zealand, a country in which unsubsidised fee-for-service is the predominant mode of remuneration in primary care. The paper assesses the impact on three important areas of clinical decision-making — prescribing, test ordering, request for follow-up — of three key conceptual dimensions — income incentives, physician agency, and clinical ambiguity (operationalised as local doctor density, practitioner encounter initiation, and diagnostic uncertainty respectively). Predictions are made about inter-practitioner variations in the rate of clinical activity in the three areas.Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. Details obtained from http://www.elsevier.com/about/policies/article-posting-policy#accepted-manuscript http://www.sherpa.ac.uk/romeo/issn/0277-9536/https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htmhttp://creativecommons.org/licenses/by-nc-nd/4.0/The "supply hypothesis" and medical practice variation in primary care: testing economic and clinical models of inter-practitioner variationJournal Article10.1016/S0277-9536(99)00299-3Copyright: Elsevier Science Ltd10626764http://purl.org/eprint/accessRights/RestrictedAccess