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Author : Jennifer Lynn Rice
Publisher :
ISBN 13 :
Total Pages : 426 pages
Book Rating : 4.3/5 ( download)
Download or read book Essays on Physicians' Incentives and Behavior in Managed Care Practices written by Jennifer Lynn Rice and published by . This book was released on 2004 with total page 426 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author : Daniel Ludwinski
Publisher :
ISBN 13 :
Total Pages : 396 pages
Book Rating : 4.:/5 (16 download)
Download or read book Three Essays on Healthcare Provider Behavior written by Daniel Ludwinski and published by . This book was released on 2017 with total page 396 pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation consists of three essays Essay 1 In recent years, the physician practice landscape has been characterized by a shift away from small, single specialty physician practices and towards larger, more integrated providers. Responses to this trend have been mixed, with some hailing it as a cost saving cure-all and others warning about the dangers of increased market power and the potential for anti-competitive behavior. This trade-off has been debated by health care professionals, economists and government agencies in boardrooms, academia and courts. The discussion of integration has been impeded by a failure to carefully define terms and distinguish between two distinct components of integration: administrative and behavioral. Administrative, or financial, integration happens when providers merge, or hospitals purchase physician practices. This type of integration is associated with increased bargaining power and higher reimbursements. Furthermore, through profit sharing, financial integration can create an incentive for providers to refer patients to other specialists for more tests or more care, some of which may be unnecessary. In contrasts, behavioral integration refers to doctors working together and coordinating care. It has been associated with decreased waste and more efficient care. Previous work has often used measures of administrative integration, such as the share of physician practices owned by hospitals, to proxy for behavioral integration. Those modeling decisions are understandable as, up to this point, a metric which separately captures behavioral integration in a systematic way has not existed. The lack of a metric has been a hurdle to evaluating these two components separately. In this paper, I use Medicare data on physician patient sharing patterns to develop metrics that capture physician practice integration at the behavioral level. I compare these behavioral integration metrics to a more standard organizational level integration metric. The low correlation, only 0.30, demonstrates that these metrics are distinct. Using all these metrics, I examine the impact of these two types of physician integration on the utilization of medical care. With national data over time, I use changes in integration and utilization within regions to estimate how the different types of integration impact the ability to provide quality care at a low cost, which I refer to as efficiency. As a model of physician behavior predicts, I find that behavioral integration reduces cost while improving quality. In contrasts, financial integration appears to increase cost without having an impact on quality. These results are robust to different measures of behavioral integration and different identification strategies. Essay 2 When health care providers and managed care organizations (MCOs) bargain, the main tool providers have is the threat to refuse to be in the MCO’s network. In fact, anecdotal evidence indicates that a major mechanism that practices employ to maximize profits in the face of differing insurer reimbursements, limited capacity and stochastic demand is to choose insurers discriminately. Providers do not accept patients from every MCO, however, providers do not exclusively accept the most profitable MCO.
Author : Nicholas George Ross
Publisher :
ISBN 13 :
Total Pages : 154 pages
Book Rating : 4.:/5 (34 download)
Download or read book Physician Financial Incentives in Managed Care written by Nicholas George Ross and published by . This book was released on 1997 with total page 154 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author : David J. Cooper
Publisher :
ISBN 13 : 9781931493147
Total Pages : 31 pages
Book Rating : 4.4/5 (931 download)
Download or read book Physician Incentives in Managed Care Organizations written by David J. Cooper and published by . This book was released on 2002 with total page 31 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author : Ivan Nikolaev Badinski
Publisher :
ISBN 13 :
Total Pages : 182 pages
Book Rating : 4.:/5 (125 download)
Download or read book Essays on Physician Innovation and Practice Style in Healthcare Markets written by Ivan Nikolaev Badinski and published by . This book was released on 2021 with total page 182 pages. Available in PDF, EPUB and Kindle. Book excerpt: This thesis consists of three chapters on technological innovation, diffusion, and practice style among physicians. The first chapter investigates the effect of age on a surgeon's propensity to use new medical procedures. I identify a large number of medical technologies undergoing diffusion by a well-defined risk set of physicians by exploiting the parent-descendant relationship among ICD9-CM inpatient procedure codes where each new code has a well-defined antecedent. I find that surgeons that are ten years older at the time of new-code approval are sixteen percent less likely to use this code. Evidence from the diffusion of new pharmaceuticals, diagnostic codes, and minimally invasive procedures suggests that this effect may be driven by skill acquisition costs rather than information frictions. In the second chapter, I study the impact of market size on the development of novel surgeries, an important domain of medical innovation where intellectual property rights, approval regulation, and financial incentives play only a minor role. Using the codification of ICD9 CM procedure codes as a novel measure of new-surgery development, I investigate the behavior of surgical innovation and compare it to pharmaceuticals where traditional innovative institutions are salient. I find that the two processes follow very different aggregate trends. Despite this difference, I estimate a positive and significant elasticity of surgical innovation with respect to potential market size by leveraging quasi-exogenous changes in potential market size due to shifting US demographics. The third chapter, joint with Amy Finkelstein, Matthew Gentzkow, Peter Hull, and Heidi Williams, studies the role of physician practice style in Medicare geographic spending variation. We estimate a model that allows for variation in patient demand, physician treatment intensity, and regional supply-side factors, as well as patient-physician sorting. The model is identified by quasi-experimental migration of Medicare patients and physicians and their matching within regions. We find that physicians vary greatly in their treatment intensity. Our baseline decomposition suggests that about 30 percent of regional variation in health care utilization is explained by differences in average physician treatment intensity, 20 percent by other area supply factors, and 50 percent by differences in patient demand.
Author :
Publisher :
ISBN 13 :
Total Pages : 562 pages
Book Rating : 4.F/5 ( download)
Download or read book Dissertation Abstracts International written by and published by . This book was released on 2007 with total page 562 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author : Maripier Isabelle
Publisher :
ISBN 13 :
Total Pages : pages
Book Rating : 4.:/5 (133 download)
Download or read book Essays in Health Economics written by Maripier Isabelle and published by . This book was released on 2018 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Webs of complex and often overlapping incentives characterize most modern healthcare systems. Some of these incentives have been purposely designed to influence the delivery of care to patients. Others emerge at the intersection of independent policies and decisions that accidentally create opportunities for arbitrage by providers of care. Using both administrative and survey data from Canada and exploiting institutional features associated with the provision of obstetric care, this thesis investigates how physicians respond to incentives embedded in their remuneration schemes, and explores longer-term consequences of such behaviour changes. The first chapter looks at primary care physicians' responses to a targeted bonus payment introduced to encourage the provision of low-volume intrapartum care in the province of Ontario. The results suggest that, while physicians do alter their behaviour in response to the introduction of explicit incentive payments, they may not do so by providing more of the services associated with the bonus. Instead, income effects may lead to a reduction in the provision of targeted services by eligible physicians, and influence their activities in other areas of their practice. The second chapter studies physicians' responses to subtler financial incentives: higher remuneration for procedures known to have close substitutes. Exploiting exogenous changes in the relative fee-for-service payment received by Canadian doctors for C-sections compared to vaginal deliveries, the findings from this chapter suggest that physicians do respond to such implicit incentives. The results also provide evidence that physicians' choice of birth delivery method might however be more strongly affected by spillovers from the publication of high-profile studies and trials results. The third chapter finally explores the potential long-term implications of physicians' responses to incentives in terms of patients' health outcomes. Investigating the impact of C-section birth on children's health outcomes later in life, and on their future consumption of care, it presents suggestive evidence that the association between the mode of delivery and some health conditions cannot be accounted for by a rich set of environmental and socioeconomic confounders. Overall, these three chapters suggest that financial incentives can shape physicians' behaviour, sometimes in unexpected ways, with both short- and long-term consequences.
Author : Institute of Medicine
Publisher : National Academies Press
ISBN 13 : 0309036437
Total Pages : 580 pages
Book Rating : 4.3/5 (9 download)
Download or read book For-Profit Enterprise in Health Care written by Institute of Medicine and published by National Academies Press. This book was released on 1986-01-01 with total page 580 pages. Available in PDF, EPUB and Kindle. Book excerpt: "[This book is] the most authoritative assessment of the advantages and disadvantages of recent trends toward the commercialization of health care," says Robert Pear of The New York Times. This major study by the Institute of Medicine examines virtually all aspects of for-profit health care in the United States, including the quality and availability of health care, the cost of medical care, access to financial capital, implications for education and research, and the fiduciary role of the physician. In addition to the report, the book contains 15 papers by experts in the field of for-profit health care covering a broad range of topicsâ€"from trends in the growth of major investor-owned hospital companies to the ethical issues in for-profit health care. "The report makes a lasting contribution to the health policy literature." â€"Journal of Health Politics, Policy and Law.
Author : Allen Buchanan
Publisher : Oxford University Press
ISBN 13 : 0199739536
Total Pages : 270 pages
Book Rating : 4.1/5 (997 download)
Download or read book Justice and Health Care written by Allen Buchanan and published by Oxford University Press. This book was released on 2009-11-05 with total page 270 pages. Available in PDF, EPUB and Kindle. Book excerpt: In this volume Allen Buchanan collects ten of his most influential essays on justice and healthcare and connects the concerns of bioethicists with those of political philosophers, focusing not just on the question of which principles of justice in healthcare ought to be implemented, but also on the question of the legitimacy of institutions through which they are implemented. With an emphasis on the institutional implementation of justice in healthcare, Buchanan pays special attention to the relationship between moral commitments and incentives. The volume begins with an exploration of the difficulties of specifying the content of the right to healthcare and of identifying those agents and institutions that are obligated to help ensure that the right thus specified is realized, and then progresses to an examination of the problems that arise in attempts to implement the right through appropriate institutions. In the last two essays Buchanan pursues the central issues of justice in healthcare at the global level, exploring the idea of healthcare as a human right and the problem of assigning responsibilities for ameliorating global health disparities. Taken together, the essays provide a unique and consistent position on a wide range of issues, including conflicts of interest in clinical practice and the claims of medical professionalism, the nature and justification for the right to health care, the relationship between responsibility for healthcare and the nature of the healthcare system, and the problem of global health disparities. The result is an approach to justice in healthcare that will facilitate more productive interaction between the normative analysis of philosophers and the policy work of economists, lawyers, and political scientists.
Author : Heather Elms
Publisher :
ISBN 13 :
Total Pages : 328 pages
Book Rating : 4.:/5 ( download)
Download or read book Professionals and Agents written by Heather Elms and published by . This book was released on 1998 with total page 328 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author :
Publisher :
ISBN 13 :
Total Pages : 304 pages
Book Rating : 4.:/5 (318 download)
Download or read book Journal of Economic Literature written by and published by . This book was released on 2005-12 with total page 304 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author : David Mechanic
Publisher : Transaction Publishers
ISBN 13 : 9781412830430
Total Pages : 268 pages
Book Rating : 4.8/5 (34 download)
Download or read book Painful Choices written by David Mechanic and published by Transaction Publishers. This book was released on 1989-01-01 with total page 268 pages. Available in PDF, EPUB and Kindle. Book excerpt: More than ever, society faces painful choices in the allocation of resources for health care. How it makes these choices, and how wise they are, will determine the quality and character of health care for years to come. David Mechanic examines existing and impending dilemmas the American health care system must manage as it confronts these choices. He explores conceptual approaches to health and health care, showing how these translate into research, and defines a strategy for informed choice. The result is a masterful volume by one of our leading medical sociologists at the peak of his career. Mechanic looks at the continuing emphasis on biomedical technology in the context of growing economic, constraints, as medical care becomes more expensive and demands become greater. He examines the discrepancy between public expectations and how health care is actually provided, and points out increasing discordance between demographic trends and disease patterns and the medical system's emphasis on acute care. Of particular concern is the enormous gap between entitlements for medical care and the increasing need for long-term care. This gap is of particular concern because of the United States's enormous investment in health care, which now consumes 11 percent of the Gross National Product, Although there is no particular consensus on what is an appropriate level of investment in health, policymakers are impatient with the medical system's apparent inability to control costs, and are concerned as well about the competition for resources between health and other sectors. Mechanic examines new trends, such as managed care, and transformation of the role of those who provide health care from patient advocates to allocators of services-a crucial distinction. The choices that will have to be made in the next decades are difficult They will also be painful, but they are inevitable. The key challenge will be to respond to the anxieties of the 37 million uninsured children and adults, the growing numbers of frail elderly, and the needs of patients with serious mental illness and other chronic disabilities. All of this must be accomplished while maintaining a high level of service for the rest of the population, and without breaking the bank. To achieve this, Mechanic argues, health services must be shaped to enhance function and quality of life, and not simply in response to technological imperatives. In its profound understanding of the social and political context, in which competitive initiative, the growth of regulation, new health care systems, and approaches for making research sensitive to patients are all evident, "Painful Choices "provides a framework for responsive and meaningful policy analysis.
Author : National Academy of Engineering
Publisher : National Academies Press
ISBN 13 : 0309120640
Total Pages : 340 pages
Book Rating : 4.3/5 (91 download)
Download or read book Engineering a Learning Healthcare System written by National Academy of Engineering and published by National Academies Press. This book was released on 2011-07-14 with total page 340 pages. Available in PDF, EPUB and Kindle. Book excerpt: Improving our nation's healthcare system is a challenge which, because of its scale and complexity, requires a creative approach and input from many different fields of expertise. Lessons from engineering have the potential to improve both the efficiency and quality of healthcare delivery. The fundamental notion of a high-performing healthcare system-one that increasingly is more effective, more efficient, safer, and higher quality-is rooted in continuous improvement principles that medicine shares with engineering. As part of its Learning Health System series of workshops, the Institute of Medicine's Roundtable on Value and Science-Driven Health Care and the National Academy of Engineering, hosted a workshop on lessons from systems and operations engineering that could be applied to health care. Building on previous work done in this area the workshop convened leading engineering practitioners, health professionals, and scholars to explore how the field might learn from and apply systems engineering principles in the design of a learning healthcare system. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary focuses on current major healthcare system challenges and what the field of engineering has to offer in the redesign of the system toward a learning healthcare system.
Author : Mark V. Pauly
Publisher : Elsevier
ISBN 13 : 0444535926
Total Pages : 1149 pages
Book Rating : 4.4/5 (445 download)
Download or read book Handbook of Health Economics written by Mark V. Pauly and published by Elsevier. This book was released on 2012-01-05 with total page 1149 pages. Available in PDF, EPUB and Kindle. Book excerpt: "As a relatively new subdiscipline of economics, health economics has made many contributions to areas of the main discipline, such as insurance economics. This volume provides a survey of the burgeoning literature on the subject of health economics." {source : site de l'éditeur].
Author : National Academies of Sciences Engineering and Medicine
Publisher :
ISBN 13 : 9780309685061
Total Pages : pages
Book Rating : 4.6/5 (85 download)
Download or read book The Future of Nursing 2020-2030 written by National Academies of Sciences Engineering and Medicine and published by . This book was released on 2021-09-30 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: The decade ahead will test the nation's nearly 4 million nurses in new and complex ways. Nurses live and work at the intersection of health, education, and communities. Nurses work in a wide array of settings and practice at a range of professional levels. They are often the first and most frequent line of contact with people of all backgrounds and experiences seeking care and they represent the largest of the health care professions. A nation cannot fully thrive until everyone - no matter who they are, where they live, or how much money they make - can live their healthiest possible life, and helping people live their healthiest life is and has always been the essential role of nurses. Nurses have a critical role to play in achieving the goal of health equity, but they need robust education, supportive work environments, and autonomy. Accordingly, at the request of the Robert Wood Johnson Foundation, on behalf of the National Academy of Medicine, an ad hoc committee under the auspices of the National Academies of Sciences, Engineering, and Medicine conducted a study aimed at envisioning and charting a path forward for the nursing profession to help reduce inequities in people's ability to achieve their full health potential. The ultimate goal is the achievement of health equity in the United States built on strengthened nursing capacity and expertise. By leveraging these attributes, nursing will help to create and contribute comprehensively to equitable public health and health care systems that are designed to work for everyone. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity explores how nurses can work to reduce health disparities and promote equity, while keeping costs at bay, utilizing technology, and maintaining patient and family-focused care into 2030. This work builds on the foundation set out by The Future of Nursing: Leading Change, Advancing Health (2011) report.
Author : Orley Ashenfelter
Publisher : Elsevier
ISBN 13 : 0444534504
Total Pages : 863 pages
Book Rating : 4.4/5 (445 download)
Download or read book Handbook of Labor Economics written by Orley Ashenfelter and published by Elsevier. This book was released on 2010-12-09 with total page 863 pages. Available in PDF, EPUB and Kindle. Book excerpt: A guide to the continually evolving field of labour economics.
Author : Ellen Frankel Paul
Publisher : Cambridge University Press
ISBN 13 : 9780521525268
Total Pages : 424 pages
Book Rating : 4.5/5 (252 download)
Download or read book Bioethics: Volume 19, Part 2 written by Ellen Frankel Paul and published by Cambridge University Press. This book was released on 2002-07-22 with total page 424 pages. Available in PDF, EPUB and Kindle. Book excerpt: Technological innovations and social developments have led to dramatic changes in the practice of medicine and in the way that scientists conduct medical research. Change has brought beneficial consequences, yet these gains have come at a cost, for many modern medical practices raise troubling ethical questions: Should life be sustained mechanically when the brain's functions have ceased? Should potential parents be permitted to manipulate the genetic characteristics of their embryos? Should society ration medical care to control costs? Should fetal stem cells be experimented upon in an effort to eventually palliate or cure debilitating diseases? Bioethicists analyze and assess moral dilemmas raised by medical research and innovative treatments; they also counsel healthcare practitioners, patients, and their families. In this anthology, fifteen philosophers, social scientists, and academic lawyers assess various aspects of this field.
