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Rodwin [2], p. 10, pointed out in quite an early study that self-employed physicians are entrepreneurs just like any other freelancers, meaning that they sell services to generate income, while the employment of physicians typically precludes entrepreneurship.
A potential approach to investigating this question could be to undertake, for a selection of comparable diagnoses, a comparison of the referral behavior of hospital physicians who run a private practice with that of contracted and non-contracted self-employed physicians without any affiliation to a hospital.
This contrast with the setting of self-employed physicians.
The self-employed physicians use the hospital facilities to provide inpatient care.
A cross-sectional study was conducted on 130 self-employed physicians practicing at six Belgian hospitals.
In France, primary care is mostly delivered by self-employed physicians in the ambulatory care sector.
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Public hospital physicians may be authorized by their employer to perform dual practice as a self-employed physician with a private practice and/or as an attending physician in private hospitals.
The complexity of the referral behavior further increases if the public hospital physician works as a self-employed physician in private practice in addition to dual practice in private hospitals.
Public hospital physicians can influence their overall income by pushing their variable income components, such as the physician fee for the treatment in the special class of the public hospital, and the income resulting from authorized dual practice as self-employed physician and/or as attending physician in private hospitals.
The impact of dual practice was also taken into consideration, because dual practice as self-employed physician or attending physician in private hospitals opens up a broad spectrum of opportunities for employed hospital physicians to act in an entrepreneurial manner, which, in turn, is supposed to interact with the service provision provided in the special class of the public hospital.
The financing of health care services implies the involvement of an individual producer, such as the hospital, the laboratory, the self-employed physician or the radiology center for example.
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