Consequences of Physicians' Ownership of Health Care Facilities — Joint Ventures in Radiation Therapy

Mitchell, Jean M.; Sunshine, Jonathan H.

doi:10.1056/nejm199211193272106

Cited by 90 publications

(66 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Equipment owners tended to order more procedures, although there were no identifiable medical reasons for doing so. The investigators concluded that equity ownership of medical equipment, and the potential to profit from its use, can lead to overutilization (Hillman et al 1990;Mitchell and Sunshine 1992).…”

Section: Ownership Return On Equity and Incentives To Lower Qualitymentioning

confidence: 99%

The Impact of Financial Incentives on Quality of Health Care

et al. 1998

View full text Add to dashboard Cite

I n t h e l a s t t w o d e c a d e s t h e f i n a n c i a larrangements in health care have rapidly multiplied and become far more complex. The constant flux in the relations between payors and plans and between plans and providers adds to the difficulty of studying the effect of a specific financial arrangement on the quality of health care provided. Nonetheless, there are good theoretical reasons to believe that financial incentives do have an impact on quality. To address this issue, we briefly describe the difficulty of defining quality and, even with a definition, the problems encountered in measuring it. We then discuss the types of financial incentives that could stimulate quality (however it is measured) and to whom payments that reward quality should be made. Because most available evidence about the impact of financial arrangements on quality is derived from studies that compare health maintenance organizations (HMOs) with fee-for-service (FFS) health plans, we build upon our earlier work and review existing data, heavily flawed though they might be. Given the limitations of these data and the need for a better understanding of the relation be-

show abstract

Section: Ownership Return On Equity and Incentives To Lower Qualitymentioning

confidence: 99%

The Impact of Financial Incentives on Quality of Health Care

et al. 1998

View full text Add to dashboard Cite

show abstract

“…14 US data suggest that physician ownership of IHFs increases the number of referrals and leads to higher costs. 15 Physicians who owned and operated diagnostic imaging equipment in their offices were up to 7 times more likely to obtain radiologic examinations than were physicians who always referred patients to radiologists. 16,17 In addition, the charges per episode of care were significantly higher for self-referring physicians.…”

Section: Defining Kickbacks and Self-referralmentioning

confidence: 99%

Unregulated private markets for health care in Canada? Rules of professional misconduct, physician kickbacks and physician self-referral

Choudhry

Choudhry²,

Brown³

2004

Canadian Medical Association Journal

View full text Add to dashboard Cite

“…Internal referral can be lucrative. Mitchell and Sunshine (1992) and Swedlow et al (1992) offer considerable evidence that physicians use joint venture affiliations to "skim the cream" from the pool of patients by self-referring those patients with the most generous insurance, and then ordering costly procedures at a rate that exceeds the national average. In fact, internal referral is deemed to be sufficiently lucrative that joint venture affiliations are thought to place physicians in ethical jeopardy.…”

Section: The Economics Of Group Practicementioning

confidence: 99%

Heterogeneity and Share Contracting in Medical Group Practices

Hackett

1995

International Journal of the Economics of Business

View full text Add to dashboard Cite

This paper offers an empirical analysis of the relationship between income sharing rules and heterogeneity in medical group practices. The economies to group formation associated with risksharing, mutual monitoring, and internal referral are served by sharing at least a portion of group income equally. Sharing group income equally is problematic, however, when group members differ in their contribution to joint income, hereafter termed "productivity." Member physicians may differ in productivity because of differences in ability, effort, or specialty field. The analysis below is addressed to the question of how income sharing rules in physician groups are affected by variation in member productivity. The analysis finds considerable evidence supporting the argument that productive heterogeneity limits the use of equal income sharing. For example, less group income is shared equally in multispecialty groups relative to single specialty groups because the former include physicians from fields with widely different income-generating potential. The same holds for specialty groups where physician services can be characterized as differentiated reputation goods, and in relatively large groups where it becomes increasingly difficult to form around homogeneous physician attributes. No such group size effect is found in multispecialty groups, which suggests that most of the quantitative effects of heterogeneity are concentrated in relatively small multispecialty groups, which by their very nature can be expected to be heterogeneous because of productivity differences across specialty fields.JEL classification D23, L14, L84

show abstract

Consequences of Physicians' Ownership of Health Care Facilities — Joint Ventures in Radiation Therapy

Cited by 90 publications

References 16 publications

The Impact of Financial Incentives on Quality of Health Care

The Impact of Financial Incentives on Quality of Health Care

Unregulated private markets for health care in Canada? Rules of professional misconduct, physician kickbacks and physician self-referral

Heterogeneity and Share Contracting in Medical Group Practices

Contact Info

Product

Resources

About