Copayments and consumer search: increasing competition in Medicare and other insured medical markets.

Between 1950 and 1980, the physician fee component of the Consumer Price Index (CPI) rose 488 percent. In contrast, an index of physician fees adjusted for 1) overall inflation, and 2) the declining proportion which is paid out-of-pocket by the patient, declined over the same 30-year period. This last observation, pointing to the erosion of the market, is important for structuring price competition for physician services. For insured patients, out-of-pocket payments arise from deductibles, coinsurance and limits, each of which is briefly discussed in this article. Following a review of Medicare Part B physician reimbursement, the paper shows that limits can be used to strengthen the incentive which insured patients have to search for less expensive medical care.

Weiskotten survey, class of 1960: a profile of physician location and specialty choice.

This survey is the eighth in a series which has included every fifth American medical school graduating class, starting with the class of 1915. The questionnaire design differed from previous Weiskotten studies and emphasized attitudes towards location information not contained in the American Medical Association Physician Masterfile. Traditional tabular comparisons are focused on contemporary locational policy needs. The findings and methodology of this study are generally similar to those of many earlier studies of both physician location and, in a very limited way, of specialty choice. The paper contains findings on certain characteristics of physicians who move their practice and those who do not. These characteristics have not been contrasted previously in this series.

Policies to influence the spatial distribution of physicians: a conceptual review of selected programs and empirical evidence.

To increase the usefulness of existing physician location literature for policy evaluation, literature is grouped into intraurban and urban-rural studies. A conceptual overview of physician location literature is presented. Consensus results, if any, are discussed. A list of hypotheses suggested by the literature is then utilized in a discussion of economic social, prior exposure, and professional development incentives embodied in selected public and private sector programs. Programs are evaluated by type of incentive mechanism and geographic target area to determine if present program structures are based on a solid empirical foundation. This assessment indicates that, in general, use of prevalent location incentive mechanisms is not justified by a consensus of empirical evidence.