ABSTRACT
Projections of a physician surplus for the 1990s have assumed that physician productivity will be constant at 1970s levels. Using the HCFA-NORC physician surveys of 1975, 1979, and 1984-85, this study examines trends in physician productivity over the past decade and estimates the impacts of physician and practice characteristics on current productivity. Visit productivity declined significantly between 1975 and 1984, suggesting that the projected surplus may be overstated. Cross-sectional results show that participation in alternative health plans is not associated with greater productivity, except for the higher work effort of independent practice association participants. The effects of physician time, nonphysician aides, and physician gender on productivity vary with alternative visit and revenues measures of productivity.
Subject(s)
Efficiency , Practice Management, Medical/trends , Cross-Sectional Studies , Data Collection , Employment , Forecasting , Office Visits , Physicians/supply & distribution , Statistics as Topic , United States , WorkABSTRACT
Physician fees have come under increasing scrutiny as policymakers attempt to constrain Medicare outlays. Our study tests the hypothesis that relative fees can be explained in terms of the physician effort involved. Our regression results show that the majority of the variation in Medicare allowed charges can be justified in terms of the physician time involved and the complexity of the procedure. Nevertheless, some surgical procedures were identified as being "overpaid" relative to their reported time and complexity, while other services appeared "underpaid," especially visits. Our methodology provides a tool for identifying "mispriced" procedures, should Congress continue its current policy of making adjustments to individual fees.
Subject(s)
Fee Schedules/statistics & numerical data , Insurance, Physician Services/economics , Medicare/economics , Task Performance and Analysis , Time and Motion Studies , Costs and Cost Analysis , Economics, Medical , Radiology/economics , Specialization , Specialties, Surgical/economics , United StatesSubject(s)
Efficiency , Group Practice, Prepaid/organization & administration , Group Practice/organization & administration , Medical Staff/standards , Data Collection , Health Maintenance Organizations/organization & administration , Office Visits , Physician Assistants/statistics & numerical data , Statistics as Topic , United StatesABSTRACT
In this article, physician participation in alternative health plans is examined, using cross-sectional data from the Physicians' Practice Costs and Income Survey, 1983-85. Overall, about one-third of physicians participated in one or more plans, ranging from 18 percent of general practitioners to 46 percent of medical subspecialists. Only 19 percent, however, received income from prepaid sources, averaging $5,275 per physician. Reasons for joining or not joining are also examined. Participants joined most often to maintain or increase workload, while nonparticipants most often declined to join because they would be giving up independence.
Subject(s)
Health Maintenance Organizations , Independent Practice Associations , Insurance, Health , Physicians/supply & distribution , Preferred Provider Organizations , Private Practice , Professional Practice Location , Professional Practice , Adult , Aged , Data Collection , Female , Humans , Income , Male , Medicine , Middle Aged , Specialization , Statistics as Topic , United States , WorkforceABSTRACT
This paper explores the access and equity implications to the poor and taxpayers of further defederalizing Medicaid program administration. New data on enrollees and tax incidence indicates little horizontal, let alone vertical, equity in the system. Styles of cost control are also examined, showing a systematic bias towards providers and taxpayers at the expense of the poor in penurious states.
