Cut off from new competition: Threat of entry and health care quality


Brüll, Eduard ; Rostam-Afschar, Davud ; Schlenker, Oliver


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URN: urn:nbn:de:bsz:180-madoc-687803
Document Type: Working paper
Year of publication: 2024
The title of a journal, publication series: ZEW Discussion Papers
Volume: 24-066
Place of publication: Mannheim
Publication language: English
Institution: Sonstige Einrichtungen > ZEW - Leibniz-Zentrum für Europäische Wirtschaftsforschung
Business School > Area Accounting & Taxation (Rostam-Afschar 2021-)
Business School > Sonstige - Fakultät für Betriebswirtschaftslehre
MADOC publication series: Veröffentlichungen des ZEW (Leibniz-Zentrum für Europäische Wirtschaftsforschung) > ZEW Discussion Papers
Subject: 330 Economics
Classification: JEL: I11 , I18 , J44 , J22 , L10 , L22 , R23,
Keywords (English): entry regulation , general practitioners , healthcare provision , threat of entry , regression discontinuity design
Abstract: We study how the threat of entry affects service quantity and quality of general practitioners (GPs). We leverage Germany’s needs-based primary care planning system, in which the likelihood of new GPs reduces by 20 percentage points when primary care coverage exceeds a cut-off. We compile novel data covering all German primary care regions and up to 30,000 GP-level observations from 2014 to 2019. Reduced threat of entry lowers patient satisfaction for incumbent GPs without nearby competitors but not in areas with competitors. We find no effects on working hours or quality measures at the regional level including hospitalizations and mortality.




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