Method of Physician Payment and Hospital Length of Stay

Egdahl, Richard H.; Taft, Cynthia H.; Linde, Kenneth J.

doi:10.1056/nejm197702102960612

N Engl J Med

1977

DOI: 10.1056/nejm197702102960612

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Method of Physician Payment and Hospital Length of Stay

Richard H. Egdahl¹,

Cynthia H. Taft²,

Kenneth J. Linde³

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1977

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An integrated theory of provider behavior in Health Maintenance Organizations

Long¹

1982

J Community Health

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It has been consistantly demonstrated in the literature that reduced medical care expenditures for Health Maintenance Organization (HMO) enrollees results from reduced hospital utilization. The cause of such behavior on the part of the HMO provider has generally been attributed to the prepayment or capitation method of financing the delivery of medical care or to the organization dynamics. This paper suggests that the problem with trying to attribute the cause of reduced hospitalization to either the payment mechanism or group dynamics is that the latter is a manifestation of the former. That is, peer review activities emerge as the result of fixed budget financing and emanate from the entity at risk. The task then becomes one of understanding the relationship between risk, incentive, behavior, and the identification of the entity at risk. Using the risk model, it can be seen that, depending on the entity perceiving the risk, controls on provider behavior can be implicit or explicit. It can also be seen that, depending on the magnitude of the perceived risk, controls can be stringently or loosely applied, or nonexistent. Much of the ambiguity in the literature regarding HMO provider behavior can be explained by the risk model developed in this work.

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An integrated theory of provider behavior in Health Maintenance Organizations

Long¹

1982

J Community Health

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Health Maintenance Organizations, 1971?1977

Strumpf¹,

Seubold²,

Arrill³

1978

J Community Health

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Promoting HMOs as part of a national health strategy began in 1971. An analysis of the data that have been accumulated in the intervening years sheds new light on the issues raised during the legislative hearings prior to the HMO Act of 1973. It describes the developmental process of the HMO program and suggests procedural modifications. It illustrates the difficulty of determining HMO viability during the early stages of operation, examines the varied hospital utilization rates of prepaid group practices and individual practice models, and suggests a hypothesis based on the dynamics of group process and peer pressure for HMO provider behavior.

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Primary Medical Practice in the United Kingdom and the United States

Robinson¹

1977

N Engl J Med

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Comparisons between the United Kingdom and the United States reveal definite differences in the style and content of primary medical practice. In the United States emphasis is on diagnosis. In the United Kingdom emphasis is on continuity and homebased care supported by a nationwide network of paramedical and social services. In both countries more is known about what discontents physicians than what satisfies patients. Medical practice and physician-patient relations are profoundly affected by external factors, including social attitudes, privileges, tradition, personal expectations and, above all, econimics. The American medical profession is the more exposed to external criticism, and future conflict and preoccupation with survival is largely an American phenomenon. Little is known in either cooutry about the long-term outcome of different forms of medical care. In Britain patients appear to value kindness above applied medical technology.

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Method of Physician Payment and Hospital Length of Stay

Cited by 5 publications

References 1 publication

An integrated theory of provider behavior in Health Maintenance Organizations

An integrated theory of provider behavior in Health Maintenance Organizations

Health Maintenance Organizations, 1971?1977

Primary Medical Practice in the United Kingdom and the United States

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