Économie et Statistique n° 455-456 - Health Systems
Are Location Strategies of French General Practitioners Driven by Economic or Hedonic Mechanisms?
France displays a high medical density but a highly uneven geographic distribution of general practitioners (GPs). Because it raises problems of fairness and efficiency, this unsatisfactory distribution has become a major issue in the regulation of medical demography. Drawing on an exhaustive sample of 9,000 GPs who entered private practice between 1997 and 2002, we analyze the determinants of GPs' personal location choices. We use the findings to describe tools that could be applied specifically at regional level to modify their location behaviour. We model two decisions: (1) the choice to move to a different region between the date of M.D. thesis defence and the establishment of the practice, and (2) the choice of region of practice, only for those physicians who left the regions where they defended their theses. Through these individual choices, we notably examine the financial attractiveness of regions in order to determine the extent to which GPs' behaviour could be influenced by bonuses for relocation to areas short of doctors. We observe distinctly sedentary behaviour among GPs, of whom a great majority open their practices in the regions where they defended their theses. Policies should therefore be directed primarily towards medical students. We also show that financial incentives to open practices in areas short of doctors could influence location choices, although the resulting shift in geographic distribution would be quantitatively modest. Bonuses would need to be very high to offset the loss of quality of life accepted by GPs. Thus financial incentives cannot be the sole instruments for correcting inequalities in the distribution of doctors.