The Exit Behavior of Doctors Under Conditions of Increasing Regulation in England and Germany - A Comparative Case Study of Service Providers in Most Different Healthcare Systems

Abstract

The present study examines how one of the main actors and key stakeholders in healthcare systems – doctors – have reacted to changing regulatory environments by engaging in exit behavior in two most different systems for comparison: the English National Health Service and the German Social Health Insurance system. Our period of observation covers the early 1990s up to 2011, which represents a period of major reform for both cases. The underlying assumption tested is that within an environment of increasing regulation in which reforms adversely affect the conditions for remuneration and professional autonomy of providers, doctors will be found to progressively exit the medical profe ssion and/or respective healthcare system. Our findings establish a strong role for regulation in conditioning the exit behavior of doctors. However, this role need not be a negative one, as we find that where regulation improves particularly the conditions for remuneration, exit decreases and supply increases. Results also point to the necessity in differentiating amongst the effects of reforms on specific doctor-groups; considering the role of gender; as well as distinguishing amongst specific forms of regulation and types of exit.