(Translated by https://www.hiragana.jp/)
Incentive for Gatekeepers and Their Demand Inducement: An Empirical Analysis of Care Managers in the Japanese Long-Term Care Insurance
IDEAS home Printed from https://ideas.repec.org/p/tky/fseres/2014cf916.html
   My bibliography  Save this paper

Incentive for Gatekeepers and Their Demand Inducement: An Empirical Analysis of Care Managers in the Japanese Long-Term Care Insurance

Author

Listed:
  • Shinya Sugawara

    (Faculty of Economics, The University of Tokyo)

  • Jiro Nakamura

    (Advanced Research Institute for the Sciences and Humanities, Nihon University)

Abstract

　　 This study analyzes incentives and supplier-induced demand of care man- agers, middlemen between consumers and service providers in the Japanese social insurance program for long-term care. Care managers can be considered as pure gatekeepers in that their function is limited to referral to specialists and they themselves do not provide care. Rewards for care managers are rendered by capitation, which is considered as a cost-effective payment mechanism for insurers. However, many care managers actually work for rms that also operate service provision sectors. The service providers are rewarded by the fee-for-service payment and have motivation to induce excess consumer demand. Thus, the violation of neutrality of care managers might yield an nancial burden on social insurance. In this study, we empirically analyze the behavior of care managers by checking whether they cause supplier-induced demand. Our estimation results detect the existence of care manager-induced demand for care managers who work for rms that jointly operate in service provision sectors; however, those who operate only care management do not induce demand. Based on the estimation results, we conduct a quantitative analysis and show that the care manager-induced produces a considerable nancial burden on social insurance. Keyword: Elderly care; Gatekeepers; Incentive; Supplier-induced demand; Japanese Long-Term Care Insurance program; Care managers

Suggested Citation

  • Shinya Sugawara & Jiro Nakamura, 2014. "Incentive for Gatekeepers and Their Demand Inducement: An Empirical Analysis of Care Managers in the Japanese Long-Term Care Insurance," CIRJE F-Series CIRJE-F-916, CIRJE, Faculty of Economics, University of Tokyo.
    • Handle: RePEc:tky:fseres:2014cf916
    as

    Download full text from publisher

    File URL: http://www.cirje.e.u-tokyo.ac.jp/research/dp/2014/2014cf916.pdf
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Brekke, Kurt R. & Nuscheler, Robert & Straume, Odd Rune, 2007. "Gatekeeping in health care," Journal of Health Economics, Elsevier, vol. 26(1), pages 149-170, January.
    2. Noguchi, Haruko & Shimizutani, Satoshi, 2009. "Supplier density and at-home care use in Japan: Evidence from a micro-level survey on long-term care receivers," Japan and the World Economy, Elsevier, vol. 21(4), pages 365-372, December.
    3. Cromwell, Jerry & Mitchell, Janet B., 1986. "Physician-induced demand for surgery," Journal of Health Economics, Elsevier, vol. 5(4), pages 293-313, December.
    4. Blomqvist, Ake & Leger, Pierre Thomas, 2005. "Information asymmetry, insurance, and the decision to hospitalize," Journal of Health Economics, Elsevier, vol. 24(4), pages 775-793, July.
    5. Iversen, Tor & Luras, Hilde, 2000. "Economic motives and professional norms: the case of general medical practice," Journal of Economic Behavior & Organization, Elsevier, vol. 43(4), pages 447-470, December.
    6. Blomqvist, Ake, 1991. "The doctor as double agent: Information asymmetry, health insurance, and medical care," Journal of Health Economics, Elsevier, vol. 10(4), pages 411-432.
    7. Rune J. Sørensen & Jostein Grytten, 1999. "Competition and supplier‐induced demand in a health care system with fixed fees," Health Economics, John Wiley & Sons, Ltd., vol. 8(6), pages 497-508, September.
    8. Marinoso, Begona Garcia & Jelovac, Izabela, 2003. "GPs' payment contracts and their referral practice," Journal of Health Economics, Elsevier, vol. 22(4), pages 617-635, July.
    9. Scott, Anthony, 2000. "Economics of general practice," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 22, pages 1175-1200, Elsevier.
    10. Office of Health Economics, 2007. "The Economics of Health Care," For School 001490, Office of Health Economics.
    11. James M. Malcomson, 2004. "Health Service Gatekeepers," RAND Journal of Economics, The RAND Corporation, vol. 35(2), pages 401-421, Summer.
    12. Shinya Sugawara, 2017. "Firm‐Driven Management of Longevity Risk: Analysis of Lump‐Sum Forward Payments in Japanese Nursing Homes," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 26(1), pages 169-204, February.
    13. Grytten, Jostein & Sorensen, Rune, 2001. "Type of contract and supplier-induced demand for primary physicians in Norway," Journal of Health Economics, Elsevier, vol. 20(3), pages 379-393, May.
    14. Shinya Sugawara & Jiro Nakamura, 2013. "Is Elderly Care Socialized in Japan? Analyzing the Effects of the 2006 Amendment to the LTCI on the Female Labor Supply," CIRJE F-Series CIRJE-F-888, CIRJE, Faculty of Economics, University of Tokyo.
    15. Dranove, David & Wehner, Paul, 1994. "Physician-induced demand for childbirths," Journal of Health Economics, Elsevier, vol. 13(1), pages 61-73, March.
    16. Allard, Marie & Jelovac, Izabela & Léger, Pierre Thomas, 2011. "Treatment and referral decisions under different physician payment mechanisms," Journal of Health Economics, Elsevier, vol. 30(5), pages 880-893.
    17. Mitchell, Jean M. & Sass, Tim R., 1995. "Physician ownership of ancillary services: Indirect demand inducement or quality assurance?," Journal of Health Economics, Elsevier, vol. 14(3), pages 263-289, August.
    18. Labelle, Roberta & Stoddart, Greg & Rice, Thomas, 1994. "A re-examination of the meaning and importance of supplier-induced demand," Journal of Health Economics, Elsevier, vol. 13(3), pages 347-368, October.
    19. Croxson, B. & Propper, C. & Perkins, A., 2001. "Do doctors respond to financial incentives? UK family doctors and the GP fundholder scheme," Journal of Public Economics, Elsevier, vol. 79(2), pages 375-398, February.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Paula González, 2010. "Gatekeeping versus direct‐access when patient information matters," Health Economics, John Wiley & Sons, Ltd., vol. 19(6), pages 730-754, June.
    2. Godager, Geir & Iversen, Tor & Ma, Ching-to Albert, 2015. "Competition, gatekeeping, and health care access," Journal of Health Economics, Elsevier, vol. 39(C), pages 159-170.
    3. Allard, Marie & Jelovac, Izabela & Léger, Pierre Thomas, 2011. "Treatment and referral decisions under different physician payment mechanisms," Journal of Health Economics, Elsevier, vol. 30(5), pages 880-893.
    4. Marie Allard & Izabela Jelovac & Pierre-Thomas Léger, 2014. "Payment mechanism and GP self-selection: capitation versus fee for service," International Journal of Health Economics and Management, Springer, vol. 14(2), pages 143-160, June.
    5. Sarah M. Hofmann & Andrea M. Muehlenweg, 2016. "Gatekeeping in German Primary Health Care - Impacts on Coordination of Care, Quality Indicators and Ambulatory Costs," CINCH Working Paper Series 1605, Universitaet Duisburg-Essen, Competent in Competition and Health, revised Sep 2016.
    6. GONZALEZ, Paula, 2003. "The "gatekeeping" role of general practitioners. Does patients' information matter ?," LIDAM Discussion Papers CORE 2003089, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
    7. Léonard, Christian & Stordeur, Sabine & Roberfroid, Dominique, 2009. "Association between physician density and health care consumption: A systematic review of the evidence," Health Policy, Elsevier, vol. 91(2), pages 121-134, July.
    8. Tor Iversen & Ching-to Ma, 2011. "Market conditions and general practitioners’ referrals," International Journal of Health Economics and Management, Springer, vol. 11(4), pages 245-265, December.
    9. Marie Allard & Izabela Jelovac & Pierre-Thomas Léger, 2010. "Physicians self selection of a payment mechanism: Capitation versus fee-for-service," Post-Print halshs-00523370, HAL.
    10. Pedersen, Line Bjørnskov & Hess, Stephane & Kjær, Trine, 2016. "Asymmetric information and user orientation in general practice: Exploring the agency relationship in a best–worst scaling study," Journal of Health Economics, Elsevier, vol. 50(C), pages 115-130.
    11. Christian Schmid, 2015. "Consumer Health Information and the Demand for Physician Visits," Health Economics, John Wiley & Sons, Ltd., vol. 24(12), pages 1619-1631, December.
    12. Sisira Sarma & Nirav Mehta & Rose Anne Devlin & Koffi Ahoto Kpelitse & Lihua Li, 2018. "Family physician remuneration schemes and specialist referrals: Quasi‐experimental evidence from Ontario, Canada," Health Economics, John Wiley & Sons, Ltd., vol. 27(10), pages 1533-1549, October.
    13. Waibel, Christian & Wiesen, Daniel, 2016. "Kickbacks, referrals and efficiency in health care markets: Experimental evidence," HERO Online Working Paper Series 2016:8, University of Oslo, Health Economics Research Programme.
    14. Ya‐Chen Tina Shih & Ming Tai‐Seale, 2012. "Physicians' perception of demand‐induced supply in the information age: a latent class model analysis," Health Economics, John Wiley & Sons, Ltd., vol. 21(3), pages 252-269, March.
    15. Yuda, Michio, 2013. "Medical Fee Reforms, Changes In Medical Supply Densities, And Supplier-Induced Demand: Empirical Evidence From Japan," Hitotsubashi Journal of Economics, Hitotsubashi University, vol. 54(1), pages 79-93, June.
    16. Jeannette Brosig‐Koch & Burkhard Hehenkamp & Johanna Kokot, 2017. "The effects of competition on medical service provision," Health Economics, John Wiley & Sons, Ltd., vol. 26(S3), pages 6-20, December.
    17. Winand Emons, 2013. "Incentive-Compatible Reimbursement Schemes for Physicians," Journal of Institutional and Theoretical Economics (JITE), Mohr Siebeck, Tübingen, vol. 169(4), pages 605-620, December.
    18. Tor Iversen & Anastasia Mokienko, 2016. "Supplementing gatekeeping with a revenue scheme for secondary care providers," International Journal of Health Economics and Management, Springer, vol. 16(3), pages 247-267, September.
    19. Adolf Kwadzo Dzampe & Shingo Takahashi, 2022. "Competition and physician-induced demand in a healthcare market with regulated price: evidence from Ghana," International Journal of Health Economics and Management, Springer, vol. 22(3), pages 295-313, September.
    20. Riise, Julie & Hole, Arne Risa & Gyrd-Hansen, Dorte & Skåtun, Diane, 2016. "GPs' implicit prioritization through clinical choices – evidence from three national health services," Journal of Health Economics, Elsevier, vol. 49(C), pages 169-183.

    More about this item

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:tky:fseres:2014cf916. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: CIRJE administrative office (email available below). General contact details of provider: https://edirc.repec.org/data/ritokjp.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.