ESSAYS ON PHYSICIAN DUAL PRACTICE IN A MIXED HEALTH CARE MARKET

Abstract

This thesis uses microeconomics theories to study the effects of dual practice in a mixed public-private health care market of a developing economy. Dual practice describes the behaviour of physicians who work in both public and private sector. We first examine the impact of dual practice on social welfare when public and private hospitals compete for patients and physicians. We develop a multi-stage game to study the strategic behaviour of each hospital and compare it to a benchmark where the physician works only in the public. We find dual practice can be socially desirable. We further study the impact of dual practice on the public health care provider focusing on China where physicians are encouraged to undertake dual practice after 2009. However despite this encouragement from the government, we find that the number of physicians engaged in dual practice is almost negligible. Therefore we employ the principal/agent framework to study this puzzle and analyse the optimal contract between public hospitals and public physicians allowing for dual practice. We show dual practice may benefit physicians but at the expense of public hospitals; this may explain why public hospitals could prevent the implementation of the reform. We propose that a partnership between public and private may counteract the negative effect of dual practice on the public providers and, therefore, improve physician's participation to undertake dual practice.

Date of Award	1 Aug 2020
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Mario Pezzino (Supervisor) & Indranil Dutta (Supervisor)