Formal professional relationships between general practitioners and specialists: possible associations with patient health and pharmacy costs

This article investigates whether the strength of formal professional relationships between general practitioners (GPs) and specialists (SPs) affects either the health status of patients or their pharmacy costs. To this end, it measures the strength of formal professional relationships between GPs and SPs through the number of shared patients and proxies the patient health status by the number of comorbidities diagnosed and treated. In strong GP–SP relationships, the patient health status is expected to be high, due to efficient care coordination, and the pharmacy costs low, due to effective use of resources. To test these hypotheses and compare the characteristics of the strongest GP–SP connections with those of the weakest, this article concentrates on diabetes—a chronic condition where patient care coordination is likely important. Diabetes generates the largest shared patient cohort in Hungary, with the highest traffic of specialist medication prescriptions. This article finds that stronger ties result in lower pharmacy costs, but not in higher patient health statuses. Key points for decision makers • The number of shared patients may be used to measure the strength of formal professional relationships between general practitioners and specialists. • A large number of shared patients indicates a strong, collaborative tie between general practitioners and specialists, whereas a low number indicates a weak, fragmented tie. • Tie strength does not affect patient health—strong, collaborative ties between general practitioners and specialists do not involve better patient health than weak, fragmented ties. • Tie strength does affect pharmacy costs—strong, collaborative ties between general practitioners and specialists involve significantly lower pharmacy costs than weak, fragmented ties. • Pharmacy costs may be reduced by lowering patient care fragmentation through channelling a general practitioner’s patients to a small number of specialists and increasing collaboration between general practitioner and specialists. • Limited patient choice is financially more beneficial than complete freedom of choice, and no more detrimental to patient health.

A gazdaságpolitikai döntéshozatal nemzetek fölötti centralizációja és a közösségi gazdaságtan. Az adóverseny elméletének néhány tanulsága (Supranational centralization of economic policy-making and community economics: some lessons from the theory of tax competition)

Mennyiben képes jelenleg a közösségi gazdaságtan az adópolitikák nemzetek fölötti centralizációjára vonatkozó politikai döntések megalapozására? Válaszunk röviden az lesz, hogy a közösségi gazdaságtan főárama - noha számos releváns gazdasági és politikai tényező hatását sikeresen elemzi - jelenleg nem kínál kielégítőnek tekinthető döntési kritériumokat a döntéshozók számára. Ennek oka, hogy központi szerepet játszik benne egy, a modellek szempontjából exogén és a közgazdasági elmélettől idegen tényező: a kormányzatok jóindulatára, pontosabban annak mértékére vonatkozó premissza. Tanulmányunk az adóverseny fiskális föderalista elméletét vizsgálja, és megpróbál általánosabb szinten is a közszektor gazdaságelméletének jelenlegi állapotára, valamint továbbfejlesztésére vonatkozó tanulságokat levonni. A kiutat az elméleti zsákutcából a kormányzati működés és döntéshozatal, valamint a kívánatos gazdaságpolitikai döntések elméletének összekapcsolása jelentheti. Erre megtörténtek az első kísérletek, de a szisztematikus és átfogó elemzés egyelőre várat magára. / === / How far can community economics provide a basis for political decision-making on supranational centralization of taxation policies? The short answer here will be that although the mainstream of community economics succeeds in analysing many relevant economic and political factors, it fails at present to provide satisfactory criteria for decisionmakers. This is because a central role is played in it by a factor exogenous to the models and alien to economic theory: the premise of the measure of goodwill from governments. The study examines the fiscal federalist theory of tax competition. It tries to draw conclusions, on a more general level, about the present state of the economic theory of the public sector and future development of it. The way out of the theoretical blind alley could be to link the theories of government operation and decision-making and of desirable economic-policy decision-making. The first attempts to do so have been made, but a systematic and comprehensive analysis is still awaited.