How Do Doctors Behave When Some (But Not All) of Their Patients are in Managed Care?

Glied, Sherry; Zivin, Joshua Graff

doi:10.3386/w7907

Cited by 46 publications

(56 citation statements)

References 6 publications

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“…This theory is consistent with the evidence on the responsiveness of physician participation in Medicaid to Medicaid fees. It is also consistent with evidence from Glied and Zivin (2002) who find that physicians with varying fractions of patients in managed care set their practice patterns according to the financial incentives inherent in the payer for the majority of their patients, rather than discriminating among their patients according to the incentives of that particular patient's payer.…”

Section: Resultssupporting

confidence: 87%

Medicaid physician fees and the quality of medical care of Medicaid patients in the USA

Decker

2007

Rev Econ Household

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When enacted in 1965, the original Medicaid legislation sought to finance access to mainstream medical care for the poor. I use data on visits to office-based physicians from the National Ambulatory Medical Care Survey in four years—1989, 1993, 1998 and 2003—to test the extent to which this goal has been achieved. Specifically, I test whether this goal has been achieved more in states that pay higher fees to physicians who treat Medicaid patients compared to states that pay lower fees. By comparing the treatment of Medicaid patients to that of privately-insured patients and by using state fixed effects, I am able to estimate the effects of changes in the generosity of Medicaid physician payment within a state on changes in access to care for Medicaid patients, therefore separating Medicaid’s effect on access to health care from any correlation between the Medicaid fee and other attributes of the state in which a patient lives. Using this method, I examine the effect of Medicaid fees on whether or not an office-based physician accepts Medicaid patients, on the fraction of a physician’s practice that is accounted for by Medicaid, and on the length of visit times with physicians. Results imply that higher Medicaid fees increase the number of private physicians, especially in medical and surgical specialties, who see Medicaid patients. Higher fees also lead to visit times with physicians that are more comparable to visit times with private pay patients. Copyright Springer Science+Business Media, LLC 2007Medicaid, Physician care, Duration of visit, I18,

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Section: Resultssupporting

confidence: 87%

Medicaid physician fees and the quality of medical care of Medicaid patients in the USA

Decker

2007

Rev Econ Household

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“…Glied and Zivin (2002) explore physician choices that affect their own financial well-being. They look at visit durations, tests ordered, medications prescribed and the scheduling of follow-up visits.…”

Section: The Literature: Recent Findings On Norms Behaviormentioning

confidence: 99%

Custom-made versus ready-to-wear treatments: Behavioral propensities in physicians’ choices

Frank

Zeckhauser

2007

Journal of Health Economics

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To customize treatments to individual patients entails costs of coordination and cognition. Thus, providers sometimes choose treatments based on norms for broad classes of patients. We develop behavioral hypotheses explaining when and why doctors customize to the particular patient, and when instead they employ "ready-to-wear" treatments. Our empirical studies examining length of office visits and physician prescribing behavior find evidence of norm-following behavior. Some such behavior, from our studies and from the literature, proves sensible; but other behavior seems far from optimal.

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“…easily measured and observable) measures of quality do not go down. Glied and Zivin (2002) found that among doctors who serve both HMO patients and FFS patients, those in an HMO experience shorter visits with the physician and are less likely to be asked to make a return visit. Scanlon et al (2003) find that it is not necessarily the HMO structure that is to blame, but the for-profit status that may be of critical importance.…”

Section: The Case Of Health Carementioning

confidence: 96%

“Selling the store” to the HMO: A life insurance contract for optimal provision of care

Burkey

2008

Journal of Economic Behavior & Organization

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How Do Doctors Behave When Some (But Not All) of Their Patients are in Managed Care?

Cited by 46 publications

References 6 publications

Medicaid physician fees and the quality of medical care of Medicaid patients in the USA

Medicaid physician fees and the quality of medical care of Medicaid patients in the USA

Custom-made versus ready-to-wear treatments: Behavioral propensities in physicians’ choices

“Selling the store” to the HMO: A life insurance contract for optimal provision of care

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