The physician market Part 1

The Physician Market, Part 1 Professor Vivian Ho Health Economics Fall 2007 These slides draw from material in Santerre & Neun, Health Economics, Theories, Insights and Industry Studies, Thomson 2007.

OUTLINE ,[object Object],[object Object],[object Object],[object Object]

*The AMA defines primary care as including family practice, general practice, internal medicine, obstetrics/gynecology, and pediatrics. Physician Market Structure (cont.)

Are there “too many” specialists and “too few” primary care docs? ,[object Object],[object Object],[object Object]

Matching Physician Supply & Requirements ,[object Object],[object Object],[object Object],[object Object]

Distribution of Physicians by Mode of Practice ,[object Object],[object Object],[object Object]

Distribution of Physician Revenues by Source of Payer ,[object Object],[object Object]

Managed Care Reimbursement of Physicians ,[object Object],[object Object],[object Object],[object Object]

Are there barriers to entry? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Is market reform better than government licensure? ,[object Object],[object Object],[object Object],[object Object]

Production, Costs, and Economies of Scale ,[object Object],[object Object],[object Object],[object Object]

Production, Costs, and Economies of Scale ,[object Object],[object Object],[object Object],[object Object],[object Object]

Production, Costs, and Economies of Scale $7.26 (1.08) $35.36** (2.12) Test interpretation $4.84 (1.35) $12.14** (2.16) Hospital visit $14.77*** (2.91) $22.14*** (3.26) Office visit, est. patient $66.34** (2.00) $59.99* (1.68) Office visit, new patient Marginal non-phys. Costs Full Marginal Cost Output

Physician Market Structure Summary ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Physician Market Conduct ,[object Object],[object Object],[object Object]

Has the over-supply of physicians led to “physician-induced demand?” ,[object Object],[object Object],[object Object],[object Object],[object Object]

Has the over-supply of physicians led to “physician-induced demand?” ,[object Object],[object Object],[object Object]

Defensive Medicine & Malpractice Reform ,[object Object],[object Object],[object Object]

Defensive Medicine & Malpractice Reform ,[object Object],[object Object]

Why do we have a malpractice system? ,[object Object],[object Object],[object Object]

PROBLEMS WITH THE CURRENT SYSTEM ,[object Object],[object Object],[object Object],[object Object]

PROBLEMS WITH THE CURRENT SYSTEM ,[object Object],[object Object],[object Object],[object Object],[object Object]

Harvard Medical Practice Study (HMPS) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

SAMPLE ,[object Object],[object Object],[object Object],[object Object]

Criteria for an Adverse Event ,[object Object],[object Object],[object Object],NEJM 1989

Which of the following is NOT an adverse event? ,[object Object],[object Object],[object Object],[object Object],[object Object],NEJM 1989

Criterion for a “negligent adverse event” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Was the following adverse event “negligible?” ,[object Object]

Determination of negligence is often difficult ,[object Object],[object Object],[object Object]

Determination of Adverse Events from Medical Records ,[object Object],[object Object],[object Object]

RESULTS 31,429 in original sample 30,195 located on first review 22,378 negative for screening criteria 7817 positive for screening criteria 7743 reviewed by physicians 6465 without adverse events 1278 with adverse events 972 with no negligence 306 with negligence Figure 1. The Record-Review Process. Numbers of medical records are shown.

Did the study cases sue for malpractice? ,[object Object],[object Object],[object Object],[object Object]

STATEWIDE ESTIMATES 27,197 adverse events due to negligence 26,764 with no malpractice claims (98%) 415 malpractice claims (2%) 14,180 with strong evidence of negligence 12,858 with disability 7462 with disability <6mo (58%) 5396 with disability >6mo (42%) 2834 patients <70yo (53%) 2562 patients  70yo (47%)

CONCLUSIONS ,[object Object],[object Object],[object Object]

FURTHER RESULTS ,[object Object],[object Object],[object Object],[object Object]

Rates of Adverse Events and Negligence Specialty Adverse Events Negligence (percentage) (percentage) Orthopedics 4.1 22.4 Urology 4.9 19.4 Neurosurgery 9.9 35.6 Thoracic & Cardiac Surgery 10.8 23.0 Vascular Surgery 16.1 18.0 Obstetrics 1.5 38.3 Neonatology 0.6 25.8 General Surgery 7.0 28.0 General Medicine 3.6 30.9 Other 3.0 19.7 P value <0.0001 0.64

Does the malpractice system deter negligence? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Defenders of the Malpractice System ,[object Object],[object Object],[object Object],[object Object],[object Object]

Recent Evidence on Defensive Medicine (Kessler & McClellan, 1996) ,[object Object],[object Object],[object Object],[object Object]

The physician market Part 1

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The physician market Part 1