Epstein A M, Krock S J, McNeil B J
Med Care. 1984 Feb;22(2):160-6. doi: 10.1097/00005650-198402000-00007.
Theoretic modeling suggests that common office tests as a group are profitable. To determine whether practicing internists perceive this profitability and whether their perceptions differ for different tests or for patients with different types of insurance coverage, the authors surveyed 111 physicians in private office practice. Respondents' estimates of receipts for tests done on patients with Medicare or Blue Cross/Blue Shield coverage were higher than their estimated costs for the testing. Estimates of receipts from Medicaid patients were lower than estimated costs of testing. After standardizing the estimated receipts from patients with different insurance coverages, the authors found that the average estimated profits for different tests on an "average insured patient" varied sixfold, from $5.99 for an electrocardiogram to $1.01 for a urinalysis. The authors suggest that perceived financial incentives are extremely variable by test. Different insurance coverages are perceived as providing varying financial incentives for testing; Medicaid provides a disincentive. Appropriate reform of the existing fee schedules should be selective by test and coverage.
理论模型表明，作为一个整体的普通办公室检查是有利可图的。为了确定执业内科医生是否认识到这种盈利能力，以及他们对不同检查或不同保险覆盖类型患者的看法是否存在差异，作者对111名私人诊所的医生进行了调查。受访者对医疗保险或蓝十字/蓝盾保险覆盖患者的检查收入估计高于他们对检查成本的估计。对医疗补助患者的收入估计低于检查成本估计。在对不同保险覆盖患者的估计收入进行标准化后，作者发现，对“平均参保患者”进行不同检查的平均估计利润相差六倍，从心电图检查的5.99美元到尿液分析的1.01美元不等。作者认为，不同检查所带来的经济激励差异极大。不同的保险覆盖被认为会为检查提供不同的经济激励；医疗补助则起到抑制作用。对现有收费标准进行适当改革应根据检查和保险覆盖情况进行有针对性的调整。
