Organizational Economics and Physician Practices (original) (raw)
Essays on Healthcare Economics
2020
This dissertation investigates how healthcare provider networks are formed and their effects on patient health outcomes. The first chapter explores three types of hospital networks that are intended to improve coordination of patient care across different hospitals: integrated delivery systems, accountable care organizations, and electronic health records.
Physician Incentives in Health Maintenance Organizations
Journal of Political Economy, 2004
Managed care organizations rely on incentives that encourage physicians to limit medical expenditures, but little is known about how physicians respond to these incentives. We address this issue by analyzing the physician incentive contracts in use at a health maintenance organization. By combining knowledge of the incentive contracts with internal company records, we examine how medical expenditures vary with the intensity of the incentive to cut costs. Our investigation leads us to a novel explanation for high-powered group incentives: such incentives can improve efficiency in the allocation of resources when the allocation process is based on the professional judgment of multiple agents. Our empirical work indicates that medical expenditures We appreciate helpful comments from the editor and an anonymous referee and from
Creating a parsimonious typology of physician financial incentives
Health Services and Outcomes Research Methodology, 2009
In order to create an empirically derived parsimonious typology of physician financial incentives that will be useful for future research, we used data from the nationally representative 2004-2005 Community Tracking Study Physician Survey (N = 6,628). Linear regression analyses informed by economic theory were used to identify the combinations of incentives associated with an overall financial incentive to expand services to individual patients. The approach was validated using two nonparametric methods (CART analysis and data mining techniques) and by examining the relationship between the resulting typology and other measures of physician behavior including hours worked, visit volume, and specialty-adjusted income. Of the 6,628 physicians surveyed, approximately 25% (1,605) reported an overall incentive to increase services and 75% (5,023) reported
Relational Dynamics and Health Economics
International Journal of Applied Behavioral Economics, 2014
Primary care physicians' and allied healing professionals are overwhelmed with greater demands to provide complex care within business structures that either mandate high volume or exorbitant fees for service in order to support healthcare needs or sustain their livelihood. Statistics within the USA note that 40 to 50 percent of primary care physicians practice consists of complicated care. There are continued decreases within the USA of medical doctors who enter general practice and most choose to enter specialties where they are able to dictate their hours of availability and are reimbursed at a higher rate for services. The exception lies in psychiatry and pediatrics, where there is a shortage of providers and low fees for service. Models that have been proposed to alleviate issues related to these shortages include models of integrated health care, where physicians provide holistic care or partner seamlessly with others to provide total care at a single location. Physician e...
Health Services Management Research, 2000
Research to date has documented• weak or inconsistent associations between market and organizational factors and the adoption of physician-organization arrangements (POAs) (e.g, physician-hospital organizations, management service organizations and independent practice associations) designed to increase physician integration. We argue that POAs may mask considerable variation in how these entities are operated and governed. Further, because the operating policies and practices of POAs are likely to influence more directly the behaviour of physicians than the structural form of the POA, they may be more sensitive to the market and organizational contingencies that encourage integration. This study attempts to test empirically the relative effects of POA type and market, strategic and organization factors on the operating policies and practices of market-based POAs. Results suggest that type of POA, and market, strategic and organizational factors affect risk sharing, physician selection practices, physician monitoring practices and ways in which monitoring information is used to influence physician behaviour in POAs.
including © notice, is given to the source. The Industrial Organization of Health Care Markets
2014
We are grateful to editor Janet Currie for support and encouragement and to her and four anonymous referees for helpful comments that substantially improved the paper. All opinions expressed here and any errors are the sole responsibility of the authors. No endorsement or approval by any other individuals or institutions is implied or should be inferred. In particular, the views expressed in this paper are those of the authors and do not necessarily reflect the views of the Federal Trade Commission, any individual Commissioner, or the National Bureau of Economic Research. At least one co-author has disclosed a financial relationship of potential relevance for this research. Further information is available online at
Organizational boundaries of medical practice: the case of physician ownership of ancillary services
Health economics review, 2012
Physician ownership of in-office ancillary services (IOASs) has come under increasing scrutiny. Advocates of argue that IOASs allow physicians to supervise the quality and coordination of care. Critics have argued that IOASs create financial incentives for physicians to increase ancillary service volume. In this paper we develop a conceptual framework to evaluate the tradeoffs associated with physician ownership of IOASs. There is some evidence supporting the existence of scope and transaction economies in IOASs. Improvement in flow and continuity of care are likely to generate scope economies and improvements in quality monitoring and reductions in consumer transaction costs are likely to generate transaction economies. Other factors include the capture of upstream and downstream profits, but these incentives are likely to be small compared to scope and transaction economies. Policy debates on the merits of IOASs should include an explicit assessment of these tradeoffs.This researc...
Socioeconomic forces affecting medicine: Times of increased retrenchment and accountability
Seminars in Nuclear Medicine, 1993
Costs of health care are increasing at a rapid rate, but both access to care and costs of care have become focal points for current national and local debates. Access issues relate not only to those who have no insurance but also to those who are underinsured. Cost issues relate most directly to radiology and nuclear medicine through their impact on coverage and payment. Increasing scrutiny is paid to criteria used for these purposes, and major changes at the federal and private level can be expected in the next decade, Finally, the ubiquitous development of practice guidelines and their expected use in physician profiles will influence the practice of medicine significantly in the future.
International Journal of Technology Assessment in Health Care, 2008
The aim of this study was to examine the impact of the multi-hundred million dollar investment by the federal government in the developing Patient Outcomes Research Teams (PORTs) in over a dozen major academic medical centers in the United States throughout the 1990s. The objective of the PORTs was to reduce unnecessary clinical variation in medical treatment. Methods: Using an economic derivation of welfare loss attributable to medical practice variation and hospital admission claims data for 2 million elderly patients generalizable to the nation, we estimate the change in welfare between 1991 and 2000, the period within which the PORTs were designed and executed and their results disseminated. Results: Our results show inpatient admission types targeted by the PORTs did have less welfare loss relative to their total expenditure by 2000, but that there was not a net decrease in the welfare loss for all hospital admissions affected by the PORT. Conclusions: We conclude that PORTs may have had favorable effects on welfare, most likely by reducing variation in clinical care, but that causality cannot be proved, and the effects were not equal across all conditions targeted by PORTs. This research provides a methodological template that may be used to evaluate the impact of patient safety research on welfare loss and on variation in medical treatment in both hospital and ambulatory settings.