Tigist Woldetsadik Sommeno
Universitetet of Oslo, Norway
Posters & Accepted Abstracts: Prim Health Care
Hirschman�¢����s (1970; 1980) analytical conceptualization of the influence of competition on exit vs. voicing, the point of departure for this study, suggests that the presence of competitive providers�¢���� fosters patients�¢���� decisions to switch GPs (exit). In Norway, the list patient system introduced in 2001 gives patients the option of changing GPs up to twice within a year. Although patient exiting can signal dissatisfaction with a particular GP, this signal is less informative about which aspect of the service is the issue. A private web-based rating site, Legelisten, was launched in Norway in May of 2012 to give patients a platform for voicing their opinions about the health care they receive, thereby also providing feedback that doctors can use to improve their services. Higher exit opportunities in a competitive market can reduce a patient�¢����s motivation to voice about his or her provider; however, online voicing creates available knowledge about GPs and becomes a public good of high interest, especially in large-market settings, leading to higher participation in voicing in these markets than in smaller ones. Hence, the papaer aims to test the influence of GP market competition on dissatisfied patients�¢���� choice to exit (switch physician) or to voice (participate in online rating) using a Norwagian GPs data from January 2010 to January 2015 by employing multilevel pannel regresion anaysis accompanied by robustness checks. The result give strong support that higher GP market competition both with and without adjusting for municipality size increased the proportion of patients switching (exit). However, for voice, higher GP market competition not adjusted for municipality size led to more participation for both dissatisfied and overall voice, while adjusted for municipality size led to less participation. This opposite effect, reflects the municipality size effect and the associated difference in the public good motive for contributing to the online voice. This result is consistent at both the GP-level and market-level analyses, strongly supporting the hypothesis adopted by this study.
Email: tigistj@gmail.com
