How French general practitioners respond to declining medical density: a study on prescription practices, with an insigh
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ORIGINAL PAPER
How French general practitioners respond to declining medical density: a study on prescription practices, with an insight into opioids use Julien Silhol1,2 · Bruno Ventelou2 · Anna Zaytseva2 Received: 11 December 2019 / Accepted: 23 July 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Disparities in physicians’ geographical distribution lead to highly unequal access to healthcare, which may impact quality of care in both high and low-income countries. This paper uses a 2013–2014 nationally representative survey of French general practitioners (GPs) matched with corresponding administrative data to analyze the effects of practicing in an area with weaker medical density. To avoid the endogeneity issue on physicians’ choice of the location, we enriched our variable of interest, practicing in a relatively underserved area, with considering changes in medical density between 2007 and 2013, thus isolating GPs who only recently experienced a density decline (identifying assumption). We find that GPs practicing in underserved areas do shorter consultations and tend to substitute time-consuming procedures with alternatives requiring fewer human resources, especially for pain management. Results are robust to considering only GPs newly exposed to low medical density. Findings suggest a significant impact of supply-side shortages on the mix of healthcare services used to treat patients, and point to a plausible increased use of painkillers, opioids in particular. Keywords Health workforce · Medically underserved area · General practitioners · Prescriptions · Opioids · France JEL Classification I14 · I18 · C31
Introduction France’s primary care medical density is one of the highest among the countries of the Organization for Economic Cooperation and Development [1]. In 2013, there was almost one GP per 1000 inhabitants in France, while the density Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10198-020-01222-8) contains supplementary material, which is available to authorized users. * Bruno Ventelou bruno.Ventelou@univ‑amu.fr Julien Silhol [email protected] Anna Zaytseva anna.zaytseva@univ‑amu.fr 1
Institut National de la Statistique et des Etudes Economiques (Insee), Montrouge, France
Aix-Marseille University, CNRS, EHESS, Centrale Marseille, AMSE, Marseille, France
2
was around 0.7 in Germany, 0.8 in the Netherlands, Italy and the United Kingdom, 1.1 in Belgium, 2.0 in Portugal and 0.3 in the United States1 [1]. However, the geographical distribution of General Practitioners (GPs) is very uneven [2–6] and, actually, some parts of the French territory could be qualified as a “medical desert” [7]. Private physicians in France, including GPs, choose freely where they wish to practice and are paid a regulated fee. As a consequence, neither the government nor the market have managed to prevent the emergence of relatively underserved areas (that could be defined as below a threshold density). Increasing numbers of
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