Physician response to fee changes with multiple payers

McGuire, Thomas G.; Pauly, Mark V.

doi:10.1016/0167-6296(91)90022-f

Cited by 352 publications

(252 citation statements)

References 14 publications

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“…The peculiarity of health market structures of transitional economics is insufficient monopsony power of payer, leaving much discretion to physician to take care of her utilities. No wonder that our findings supported the hypothesis on discretionary power of physician in tune with numerous researches [9][10][11][12]. The closest empirical model and findings pertained to researchers who studied changes of physician practices as response to transition from fee for services (FFS) based remuneration to mixt of FFS and hourly based salary [2,13].…”

Section: Discussionsupporting

confidence: 65%

The influence of competition on quality of hospital treatment from physician behavior perspective (theoretical model verification with case presentation from Vinnitsa, Ukraine)

Yaremyna

Ocheredko

2017

ScienceRise: Medical Science

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Material and MethodsTo check the deduction stemming from the theoretical model of physician behavior on part of possible impairment of quality under market monopoly we exploited competing risk modeling having in mind 2 types of subsequent admissions:-the same cause as in previous admission; -different cause. It ensures us to use two types of censoring, both informative and non-informative. The non-informative censoring tells on termination of tracing before the next admission. The majority of cases demonstrated non-informative censoring. Informative censoring denotes admission due to the different cause then previous. Absence of censoring refers to subsequent admission due to the same cause as previous. Yet another, third type of censoring related to lethality. It's known as terminal event censoring. It's actually the informative censoring that precludes any following censoring or risk accumulation. If we denote Т ij as j th admission episode in і th patient with the same cause as previous Y ij -with different cause, С ij -censoring because of termination of tracing, each period between successive admissions can be classified by: 1) admission due to the same cause with frailty Z 1 with gamma distribution resulted from sum of independent gamma distributed variables Y 0 and Y 1 ;2) admission due to the different cause with gamma distributed frailty Z 2 resulted from sum of independent gamma distributed variables Y 0 and Y 2 ;3) terminal event with gamma distribution resulted from sum of independent gamma distributed variables Y 0 and Y 3 .The mutual variable Y 0 serves commonality in individual risks. Indeed, all three events induced by health problem of particular patient, the fact captured by Y 0 . To get into practicalities we used:This ensures simple first and second moments of frailties distributions:Therefore, co-variation between Z 1 and Z 2 is:With simple correlation formulae (ρ):Specification of events rendered by particular independent variables Y 1 , Y 2 , and Y 3 . Event specification also ingrained into specific linear predictors.Thereby, competing risks incorporated into mixed proportional hazard model (MPH) by:-censoring system (1), incorporating each admission due to the same cause precludes admission due to the different cause and counterwise; lethality introduces another competing risk that upon happening terminates exposure to competing risks; -expression of Z 1 and Z 2 as gamma distributed with common elements of shape and scale k 0 (2), thereby ensuring certain commonality in risks of competing events under consideration; -correlation coefficient ρ between frailties Z 1 and Z 2 , evaluating competing risks commonalities;-association between frailties Z 1 and Z 2 and frailty of terminal event Z 3 through common Y 0 . Copula.mode <-multivPenal(Surv(Between,Censored1)~ cluster(ID) + T + Dep + Exigent+ Order + Status1 + Holiday + Office + Age + Sex + Occupationc + CharlsonI + Ecallc + dStatus + Monthc + Diagnose1 + event2(Censored2) + terminal(Censored3), formula.Event2 =~ T + Exigent + Status2 +...

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Section: Discussionsupporting

confidence: 65%

The influence of competition on quality of hospital treatment from physician behavior perspective (theoretical model verification with case presentation from Vinnitsa, Ukraine)

Yaremyna

Ocheredko

2017

ScienceRise: Medical Science

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“…There is considerable evidence that physicians respond to the incentives embedded in different payment schemes (McGuire and Pauly 1991;McGuire 2000;Hurley et al 1990;Yip 1998;Nguyen and Derrick 1997;Hickson et al 1987;Krasnik et al 1990;Scott and Shiell 1997). There is less evidence on physician in responses to explicit financial incentives in the form of targeted performance payments intended to guide specific behaviours.…”

Section: Empirical Evidence On Physician Response To P4pmentioning

confidence: 99%

Physician Response to Pay-for-Performance: Evidence from a Natural Experiment

Hurley

DeCicca

et al. 2011

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Explicit financial incentives, especially pay-for-performance (P4P) incentives, have been extensively employed in recent years by health plans and governments in an attempt to improve the quality of health care services. This study exploits a natural experiment in the province of Ontario, Canada to identify empirically the impact of pay-for-performance (P4P) incentives on the provision of targeted primary care services, and whether physicians' responses differ by age, practice size and baseline compliance level. We use an administrative data source which covers the full population of the province of Ontario and nearly all the services provided by practicing primary care physicians in Ontario. With an individual-level data set of physicians, we employ a difference-in-differences approach that controls for both "selection on observables" and "selection on unobservables" that may cause estimation bias in the identification. We also implemented a set of robustness checks to control for confounding from the other contemporary interventions of the primary care reform in Ontario. The results indicate that, while all responses are of modest size, physicians responded to some of the financial incentives but not the others. The differential responses appear related to the cost of responding and the strength of the evidence linking a service with quality. Overall, the results provide a cautionary message regarding the effectiveness of pay-for-performance schemes for increasing quality of care.

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“…Seminal work in this area has focused on demand inducement, where financial incentives may increase the quantity of services recommended and delivered by physicians beyond the point at which the medical benefits of such services justify their costs (Evans, 1974;McGuire and Pauly, 1991;Labelle et al, 1994;Gruber and Owings, 1996). Prior work on referrals by physicians for office-versus hospital-based care has highlighted the effects of financial incentives on decisions regarding the utilization of resources for the care of acute conditions (Marinoso and Jelovac, 2003;Blomqvist and Léger, 2005;Bain and Morrisey, 2007;David and Helmchen, 2010).…”

Section: Introductionmentioning

confidence: 99%

Physician division of labor and patient selection for outpatient procedures

David

Neuman

2011

Journal of Health Economics

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Little is known about the ability of incentives to influence decisions by physicians regarding choices of settings for care delivery. In the context of outpatient procedural care, the emergence of freestanding ambulatory surgery centers (ASCs) as alternatives to hospital-based outpatient departments (HOPDs) creates a unique opportunity to study this question. We advance a model where physicians' division of labor between ASCs and HOPDs affects the medical complexity of patients treated in low-acuity settings (i.e. ASCs). Analyses of outpatient surgical procedure data show that physicians working exclusively in low-acuity settings (i.e. ASCs) treat patients of significantly higher medical complexity in these settings than do physicians who also practice in higher-acuity settings (i.e. HOPDs). This discrepancy shrinks with increasing procedural risk and with increasing distance between ASCs and acute care hospitals. AbstractLittle is known about the effect of incentives on physicians' choices of settings for medical procedures. We advance a model where physicians' division of labor between ambulatory surgery centers (ASCs) and hospital-based outpatient departments (HOPDs) affects the medical complexity of patients treated in low-acuity settings (i.e. ASCs). Analyses of outpatient surgical procedure data show that physicians working exclusively in low-acuity settings (i.e. ASCs) treat patients of significantly higher medical complexity in these settings than do physicians who also practice in higher-acuity settings (i.e. HOPDs).This discrepancy shrinks with increasing procedural risk and with increasing distance between ASCs and acute care hospitals.

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Physician response to fee changes with multiple payers

Cited by 352 publications

References 14 publications

The influence of competition on quality of hospital treatment from physician behavior perspective (theoretical model verification with case presentation from Vinnitsa, Ukraine)

The influence of competition on quality of hospital treatment from physician behavior perspective (theoretical model verification with case presentation from Vinnitsa, Ukraine)

Physician Response to Pay-for-Performance: Evidence from a Natural Experiment

Physician division of labor and patient selection for outpatient procedures

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