Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Avenue, Rm 433, Boston, MA 02115.
Health Serv Res. 2014 Aug;49(4):1348-63. doi: 10.1111/1475-6773.12165. Epub 2014 Mar 11.
To assess whether patient choice of physician or health plan was affected by physician tier-rankings.
Administrative claims and enrollment data on 171,581 nonelderly beneficiaries enrolled in Massachusetts Group Insurance Commission health plans that include a tiered physician network and who had an office visit with a tiered physician.
We estimate the impact of tier-rankings on physician market share within a plan of new patients and on the percent of a physician's patients who switch to other physicians with fixed effects regression models. The effect of tiering on consumer plan choice is estimated using logistic regression and a pre-post study design.
Physicians in the bottom (least-preferred) tier, particularly certain specialist physicians, had lower market share of new patient visits than physicians with higher tier-rankings. Patients whose physician was in the bottom tier were more likely to switch health plans. There was no effect of tier-ranking on patients switching away from physicians whom they have seen previously.
The effect of tiering appears to be among patients who choose new physicians and at the lower end of the distribution of tiered physicians, rather than moving patients to the "best" performers. These findings suggest strong loyalty of patients to physicians more likely to be considered their personal doctor.
评估患者对医生或医疗计划的选择是否受到医生层级排名的影响。
马萨诸塞州团体保险委员会健康计划中 171581 名非老年受益人的行政索赔和登记数据，这些计划包括一个分层医生网络，并且有一位分层医生的门诊就诊记录。
我们使用固定效应回归模型估计层级排名对计划内新患者医生市场份额以及医生患者中转向其他医生的比例的影响。使用逻辑回归和前后研究设计来估计分层对消费者计划选择的影响。
底层（最不受欢迎）的医生，特别是某些专科医生，新患者就诊的市场份额低于排名较高的医生。其医生在底层的患者更有可能更换医疗计划。层级排名对从之前看过的医生那里转走的患者没有影响。
分层的影响似乎在选择新医生的患者中以及在分层医生分布的低端存在，而不是将患者转移到“最佳”医生那里。这些发现表明，患者对更有可能被认为是他们私人医生的医生有强烈的忠诚度。
