Supplier Inducement in the Belgian Primary Care Market

We address the presence of supplier-induced demand in the Belgian primary care market, which is characterized by a …xed fee system and a high density of General Practitioners (GP). Using a unique dataset on the number of visits of all Belgian GPs, we …rst investigate whether we can …nd evidence of demand inducement by Belgian GPs. Novel to this literature is that we furthermore investigate which type of visits GPs typically use for inducing demand. We extend the theoretical framework of Carlsen and Grytten (1998) to allow for a limitation in the possibility of inducing demand due to the amount of information in the market. As a result, our model predicts GPs to induce demand when the level of competition becomes high, while a further increase of competition triggers a decrease in their inducing behavior. The results indicate the presence of both availability e¤ects and supplier inducement in the Belgian primary care market. We also …nd that GPs prefer the use of home visits during working hours to induce demand for their services. However, when competition gets …erce, they substitute toward inducement through o¢ ce visits. Keywords: supplier induced demand, GP, Belgium Acknowledgements: I am grateful to RIZIV/INAMI for providing the data used in this paper and to J.P. Dercq, A. Thijs, E. Koopmans and D. Bodart in particular for data support. I also thank Frank Verboven for the useful comments and suggestions. Finally, I gratefully acknowledge …nancial support by the Flemish Science Foundation (FWO, G.0089.04).