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Julio C. Saavedra – Call the doctor

11. Oktober 2007

A medical doctor (the precision must be made: the VfS convention is teeming with other kinds of doctors) recently complained that Germans rush to call the emergency physician at the slightest increase in temperature. But could it be that the doctors themselves now and then induce demand for medical services? And if so, is it equally so for privately insured patients as for the statutorily insured ones (ie, those affiliated to a Krankenkasse)?

The doctor in question also complained about how little she earns. Does that mean that MDs in general earn too little, or that women doctors earn less than their male counterparts, as in virtually every other labor market?
Both groups of questions found an answer in one of this morning’s sessions.
Hendrik Jürges, of the University of Mannheim, found that privately insured patients are initially less likely to contact a physician, but that once they do contact one, they tend to visit the doctor more frequently thereafter. Physician density, in turn, was found to have a significantly positive effect on both the decision to contact a physician and on the frequency of visits thereafter among statutorily insured patients, while it had no effect on the initial contact in the case of privately insured ones, but exerted quite a strong one on visits thereafter. This was construed by Jürges as to provide indirect evidence that, in Germany at least, physicians appear induce demand for medical services among privately insured patients but not among the statutorily insured.
As regards earning gaps between male and females physicians, a lot of data is available on the US, which has a system dominated by health care providers that leaves room for physicians to maximize income by setting their prices more or less discretionarily. The interesting question is to see whether the same happens in a Bismarckian system like the one in Germany and Austria, where physicians have scant room for setting prices individually.
Engelbert Theurly and Hannes Winner, both from the University of Innsbruck, explored this question using real income data instead of just survey data, which tends to be less reliable, for an Austrian province between 2000 and 2004. They found that here, too, female physicians earn up to 30% less than male ones. Given that a substantial part of this difference (around 46 to 64%) cannot be explained by personal and market characteristics, it seems like gender discrimination is at work here.

Julio C. Saavedra

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