Rossiter Louis F
From the Raymond A. Mason School of Business, College of William & Mary, Williamsburg, Virginia.
South Med J. 2018 Oct;111(10):597-600. doi: 10.14423/SMJ.0000000000000876.
The American Medical Association has reported that 2016 was the first year in which fewer than half (47.1%) of all practicing physicians owned their own practice. Across the United States, there has been consolidation of physicians and hospital and health systems, resulting in questions about the effect of this on healthcare expenditures. The aim of this study was to compare the expenditures per patient between hospital- and health system-affiliated physicians and independent physicians.
The author used Virginia's new statewide all-payer claims database to analyze expenditures and quality for 3 years for hospital- and health system-affiliated physicians versus independent physicians. The database had all claims statewide for Virginians with individual or group commercial insurance coverage: 1.95 million patients in 2013, 2 million in 2014, and 2.1 million in 2015. The average annual expenditure for each physician was adjusted for average patient condition burden (risk) and differences in geographic input costs using regression analysis. Measures of primary care quality were obtained from the claims data using evidence-based measures from national health quality organizations.
Hospital- and health system-affiliated physicians had annual expenditures per patient ranging from 10.3% to 14.6% higher than independent physicians. Most of the measures of primary care quality were not significantly different.
Virginia patients, employers, and managed care companies incurred higher per-patient expenditures with hospital and health system physicians than with independent physicians.
美国医学协会报告称，2016年是所有执业医师中拥有自己诊所的人数不足半数（47.1%）的第一年。在美国各地，医师与医院及医疗系统进行了整合，这引发了关于此举对医疗保健支出影响的质疑。本研究的目的是比较隶属于医院和医疗系统的医师与独立医师的人均支出。
作者利用弗吉尼亚州新的全州范围全支付方索赔数据库，分析了隶属于医院和医疗系统的医师与独立医师在3年期间的支出和质量情况。该数据库包含了弗吉尼亚州所有拥有个人或团体商业保险的居民的全部索赔信息：2013年有195万名患者，2014年有200万名，2015年有210万名。通过回归分析，针对每位医师的平均年度支出，根据患者平均病情负担（风险）和地理投入成本差异进行了调整。初级保健质量指标是利用国家卫生质量组织基于证据的指标从索赔数据中获取的。
隶属于医院和医疗系统的医师的人均年度支出比独立医师高出10.3%至14.6%。大多数初级保健质量指标没有显著差异。
与独立医师相比，弗吉尼亚州的患者、雇主和管理式医疗公司在医院和医疗系统医师处的人均支出更高。
